JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
LSU AgCenter Nutrition Programs
Fill out this form to sign up for one of our nutrition education programs. If a date is not set for your preferred program, you will be contacted when it is available. For Terrebonne and Lafourche residents only.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
Address (street, City, Zip Code)
*
Your answer
Parish
*
Your answer
Phone number (XXX)-(XXX)-(XXXX)
*
Your answer
How would you prefer we contact you?
*
Phone
Email
Which program are you interested in joining? Select all that apply.
*
Let's Eat for the Health of It
Smart Portions
Dining with Diabetes
Small Changes, Healthy Habits
Grocery Store Tour
Kid Chef Camp (youth) **only in summer
Greauxing at Home
I am not sure. Please contact me.
Other:
Required
What time are you most available to attend these classes? Select all that apply.
*
Morning
Afternoon
Evening
Other:
Required
Do you require any special assistance to participate in this program?
yes
No
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
