Application for Recognition as a
Breastfeeding Friendly Health Department:
Step 3
To apply for completion of Step 3:
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 3: Coordinate breastfeeding support and promotion with other programs in the
health department, private and public health care systems, and community
organizations to establish breastfeeding as the “norm” in the community
A. Ensure breastfeeding mothers are given contact information of community-based breastfeeding support groups
and individual breastfeeding services
Provide resource list used, including both prenatal and postpartum resources (attach to email)
B. Coordinate information and promotion of breastfeeding with other programs, systems and/or organizations
Provide an example of how
your health department is
coordinating information
with one or more of the
following groups: WIC
Program, schools, hospitals,
medical clinics, health care
providers (e.g. pharmacists,
home visiting staff)
C. Collaborate with partners or coalitions to advocate for support and accommodation of breastfeeding women
Provide an example of how
you have worked with
partners or coalitions to
advocate for support and
accommodation of
breastfeeding women
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