Nutrition Education Program Referral - Cornell Blogs Service 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the designated field. This is essential for identifying the individual referred.
3. Fill in your street address, city, and zip code to ensure accurate location details.
4. Provide a phone number and indicate the best time to call you for follow-up.
5. In the section regarding food assistance, check the boxes if applicable for Food Stamps or WIC.
6. Indicate the number of people living in your home to help assess needs.
7. Complete the referral information by providing your name, phone number, agency details, and basis for referral.
8. Answer whether the individual or family is aware of this referral and if they are willing to receive a call from Nutrition staff.

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