Add Your Program to the Directory

To add your program to the directory, complete the form below and press the Submit button. Please be as clear, concise and complete as possible when describing your program.

All submissions will be reviewed by Minding Our Bodies staff prior to publication in the online directory. Submissions may be edited for length and clarity. We reserve the right to refuse to publish any submission or to remove listings from the directory without prior notice.

For more information, please Contact Us.

Your Contact Information

Contact information for person who is submitting program for addition. The information below is for administrative purposes only and will not be listed publicly.

Full Name: *

Job Title: *

Phone Number (with Area Code): *

E-mail: *

Program Contact Information

The following information will be listed publicly in the program directory.

Contact Name: *

Full name of contact person for your program. If you prefer that an individual not be listed in the directory, please enter "N/A".

Job Title: *

Organization Name: *

Address: *

Mailing address for your organization (street, city, postal code, etc.)

Phone Number (with Area Code): *

E-Mail: *

Website: http://

Organization Description: *

Briefly describe your organization, including your mission and clients served.

Program Description

Program Title: *

The name of your program

Short Program Description: *

Briefly describe your physical activity/healthy eating program (one sentence).

Full Description: *

Provide a description of your physical activity/healthy eating program: What activities do you offer? Who is the program intended to serve? Who delivers the program? How often do you meet? How is your program innovative or unique? Etc.

Health Promotion Activities: *

Do you offer related activities, such as education about diabetes or other chronic conditions, smoking cessation, etc.?

Partnerships: *

Do you work with any partner organizations in your community to deliver your program? Please describe your partners and the role(s) they play.

Peer Leadership: *

Do you involve consumers in the planning or delivery of your program? Do you provide any peer leadership training opportunities? Please describe.

Program Funding:

Who provides funding for your program?

Evaluation:

Do you evaluate the program? If so, how? What were the results?

Challenges and Successes:

Briefly describe any challenges your program has faced and/or successes you've experienced.

Program Location

Please enter the main location of your program. This information will be used to locate your program on a map of Ontario.

If your program is delivered in more than one location, please enter the primary location here and describe additional locations in the Comments field below. (Note: You do not need to identify every location where your activities take place, just the central locations. You may choose to list only your office location.)

Location Name: *

Street Address: *

Additional:

City: *

Province: *

Postal Code: *

Comments

Comments:

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