Skip to content
Search
Search
EN ESPAÑOL
IN ENGLISH
EN ESPAÑOL
IN ENGLISH
Search
Search
Day:
May 3, 2024
Newborn Feeding Secrets Class
Register Ask your questions apply for wic
Home
I want WIC
I’m on WIC
Services
More Good Stuff
Referrals
Contact
Home
I want WIC
I’m on WIC
Services
More Good Stuff
Referrals
Contact
Apply for Achieve Wellness Program
Achieve Sign Up
First Name
*
Last Name
*
Phone Number
*
Email Address
*
What is the best way for us to contact you?
*
Text
Email
Call
After the three introductory classes, does meeting on Tuesdays 4 - 6 p.m. or Saturdays 10 a.m. - 12 p.m. work for you?
*
Yes
No
Children are welcome. If you plan on bringing your children, please list how many children you have and their ages.
*
In order to begin the program, participants must attend our introductory classes on Saturdays from 1 – 3 p.m. for three weeks in a row. Are you able to attend these classes?
*
Yes
No
If enrolled in the program, you will be required to: Track your minutes of physical activity, track your food intake, contact your buddy once a week, bring your Achieve notebook to class every week. Are you willing to do these things?
*
Yes
No
Are you planning to move within the next six months?
*
Yes
No
How important is it for you to complete this program?
*
1. Not at all important
2. Slightly important
3. Moderately important
4. Very important
5. Extremely important
How confident are you that you can complete this program?
*
1. Not at all confident
2. Little confidence
3. Neither
4. Somewhat confident
5. Very confident
What challenges do feel you may have in attending the meetings?
*
If you are human, leave this field blank.
Submit
Apply for WIC
Apply - Short
Name
*
First
Last
*
Last
Email
*
Phone Number
*
If you are human, leave this field blank.
Submit