Application for Recognition as a
Breastfeeding Friendly Health Department:
Step 4
To apply for completion of Step 4:
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 4: Collaborate with community partners to ensure access to breastfeeding
classes for prenatal women
A. Identify available prenatal breastfeeding classes within the community
List available prenatal
breastfeeding classes
B. Identify barriers to accessing classes for any/all populations within the community such as language, cost and
location
Document barriers (describe
here or provide an
attachment or web page link)
C. Work collaboratively with community partners/OB providers to fill the gaps and eliminate the barriers
Document your plan to work
with community partners to
address existing barriers and
eliminate gaps in service
(describe here or provide an
attachment or web page link)
Office Use:
Received on
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
Filed on
Site ID