Current DP Program Enrollment Form

DPP Eligibility Enrollment Questions

Please answer the questions below to begin enrollment.
Name*

First NameLast Name
1. To be eligible for a CDC-recognized lifestyle change program, you must meet ALL of the following criteria: (Select all that apply)*

Be 18 years or olderBe overweight (body mass index above 24, or 22 if you are Asian)Have NOT been diagnosed with type 1 or type 2 diabetesNOT be pregnant
2. Check ONE of the following criteria:*
If you haven't taken the prediabetes test: Take the Prediabetes Test
If you checked Box 3 in Question #2 and took the Prediabeties Test Please print and save results and upload the information below.

Upload Prediabetes Test Results

Cancelof

DPP Payment Information

Please follow the instructions below to make your payment. Program cost is $240.00 due at time of registration. To ensure your placement in the program, payment must be received before program start date.
Three options to make your payment

Option One: Adventist Giving (please click the link)

Adventist Giving Important Instructions:
- Under the "Local Church" section click "More Offering Categories"
- Check the "Miscellaneous" box
- Click "Back to Envelope"
- Input the total amount of payment in the newly added "Miscellaneous" box
- Click continue
- Check out as a guest or you may register
Option Two: Send payment through our cash app $BladensburgSDA

CashApp important information:
- Please include the following information in the memo line: "DPP & Participant's First Letter of First Name followed by Participant's Last Name" (example - Jay Smith = DPP - J.Smith)
Option Three: Contact us if you would like a payment plan or you have payment concerns.
How will you make your payment? Check One*

Adventist GivingCash AppPayment plan/concerns
Should be Empty:

DPP Eligibility Enrollment Questions