Thank you for your interest in becoming a Breastfeeding Friendly Employer.
  • Complete the Breastfeeding Friendly Employer Checklist to indicate the lactation accommodations your business offers. 
  • Save completed checklist on your computer.
  • Enter your business contact information below.
  • Upload the completed Breastfeeding Friendly Employer Checklist.
For more information, please contact the State Breastfeeding Coordinator.

 

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* 1. Name of Employer/Business

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* 2. Mailing Address

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* 3. City/State/Zip

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* 4. County

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* 5. Phone

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* 6. Website

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* 7. General Business/Organization Email

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* 8. Contact Person

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* 9. Title/Role

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* 10. Contact Person Email

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* 11. Number of Full-time Employees

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* 12. Number of Part-time Employees

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* 13. Number of Locations (If applicable, please list all locations)

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* 14. Please upload the completed Breastfeeding Checklist.

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