Submit to Nan
Submit to Jennifer
HISD Nutrition Education Request Form SY 15-16
Please fill out the following form to request a nutrition education class or participation by the
Nutrition Services Team at your school and/or community event. Completed forms must be
submitted a minimum of two weeks prior to the requested date(s) to be considered.
Once a request has been received, you will be notified by the appropriate dietitian to confirm
the details and date of your request.
School Name:
Contact Person / Event Coordinator:
Email Address:
Phone Number:
Check the request type:
Student Nutrition Education
(Student-focused)
Community Outreach
(Adult-focused)
Student Nutrition Class or Presentation
Student-focused Health Fair or Festival
SMATH or Literacy Night, etc.
Career Day
Resources, Material, or Curriculum
Mobile Dairy Classroom
School Food Culinary Demos or Sampling
Parent Nutrition Class or Presentation
Staff Nutrition Class or Presentation
PTO/PTA Meeting Presentation
Open House
Community Health Fair
Coffee with the Principal
Other
Preferred Presentation Date(s) OR Date & Time of Event:
Requested Nutrition Presentation Topic (if applicable):
Estimated Number of Total Participants:
Class Time Frame
Ex: 10am-10:45am
Grade
th
4 grade
Class Size
100 (4 classes of 25 each)
For requests under the “Student Nutrition Education” section, please submit to:
Jennifer Lengyel at jgriffi4@houstonisd.org or 713-491-5729
For requests under the “Community Outreach” section, please submit to:
Nan Cramer at ncramer@houstonisd.org or 713-491-5874