TFLC Tobacco-Free Business Champion Application
We want to celebrate tobacco-free businesses and organizations in Lincoln and Lancaster County by highlighting Tobacco-Free Business Champions. Not only will you be recognized for the great work your business/organization does to support tobacco-free living, but can also serve as an example for businesses in the community.

Our goal of recognizing tobacco-free business champions is to normalize tobacco-free campuses.

This honor will be highlighted in print advertisement, on social media and direct communication with other local businesses.  Separate Tobacco-Free Business Champions will be awarded in June 2021 and November 2021.

Please fill out this form by October 31,2021 to apply to be the next TFLC Tobacco-Free Business Champion.

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Company Name *
Company Address, please include zip code *
Contact name and title *
Contact e-mail *
Contact phone number *
What is the size of your business/organization? *
How long has your business/organization had a tobacco-free policy? *
Which of the following does your tobacco-free policy include? (select all that apply) *
Required
I have emailed a copy of my tobacco-free policy to info@tobaccofreelancastercounty.org
Clear selection
What percentage of your employees currently use tobacco products (including cigarettes, chew, and e-cigarettes)? *
What is the estimated number of employees that have quit tobacco use since implementing a tobacco-free policy? *
Share a testimonial of an employee that supports your tobacco-free policy.  This could be someone who quit tobacco as a result of policy implementation, an individual who helped champion the cause, or someone who appreciates a smoke-free workplace.
How have you encouraged your employees/clients to stay or become tobacco-free? (select all that apply) *
Required
In 250 words or less, please describe what makes your business/organization a Tobacco-Free Champion. *
Would you like to receive resources about tobacco prevention, education, and events from TFLC?  (approximately 1 email per month) *
Thank you for your application!  
We will confirm your submission by email within one week. Applications will be reviewed by LLCHD/TFLC staff and members of Tobacco-Free Business Champion committee from the TFLC Business/School Task Force.  The next Tobacco-Free Business Champion will be announced in June 2021 and a second winner in November 2021.  If selected, you will be contacted prior to announcement. Please contact us at info@tobaccofreelancastercounty.org if you have questions or need assistance.
Funding provided by the Nebraska Department of Health and Human Services/Tobacco Free Nebraska Program as a result of the Tobacco Master Settlement Agreement.”  
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