Application for Recognition as a
Breastfeeding Friendly Health Department:
Step 5
To apply for completion of Step 5:
Complete this form electronically using Adobe Acrobat or Adobe Reader 9.1 or later. Adobe Reader is a free
application that can be downloaded from the internet. Save the form to your computer and submit it by email as an
attachment to [email protected], along with any required supplemental documents (see below), a cover sheet,
and applications for the other steps your health department has completed. See the web page or the cover sheet for
more details about the application process.
Note: Any place you are asked to attach a document or enter text it is acceptable to provide a link to a current web
page instead. An attachment is also acceptable as an alternative to entering text directly on this form.
Step 5: Educate the community on breastfeeding support
A. Increase community awareness by sharing the health department breastfeeding policy
List communication
method(s)
B. Provide basic information on breastfeeding support and management
Provide an example of how
your health department has
worked or is currently
working with community
partners to share basic
information on breastfeeding
support and management
(may attach educational
brochure or link to a website
as the example)
C. Increase community awareness of breastfeeding friendly messages
List communication
method(s) you are using to
increase community
awareness of breastfeeding
friendly messages
Office Use:
Minnesota Department of Health
Office of Statewide Health Improvement Initiatives
P.O. Box 64882, St. Paul MN 55164-0882
www.health.mn.state.us/divs/oshii
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