Language
English (US)
Español
Minority Health Month 2026
Join Us! Breastfeeding Education Workshops.
Name
*
First Name
Last Name
Date of Birth
*
Race/Ethnicity
*
Please Select
White
Black or African American
Hispanic or Latino
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Other
Unknown
Address
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Status
*
Pregnant
Postpartum
Other
Are you currently enrolled in Ohio Medicaid?
*
Yes
No
Pending
Insurance Provider?
*
Please Select
Buckeye Health Plan
Care Source
Molina Health Care
Paramount Advantage
United Health Care Community Plan
Traditional Medicaid
Other
Non-Applicable
Are you currently receiving any breastfeeding services/support?
*
Yes
No
Select date to attend workshop
*
Please Select
April 4, 2026 12:00p.m-2:00 p.m. Breastfeeding Education Workshop, Summit Lake Community Center Akron, OH
April 25, 2026 12:00 p.m -2:00 pm Breastfeeding Education Workshop, Summit Lake Community Center , Akton , OH
Additional Information (e.g. interpreter needed/language spoken)?
How did you hear about Project Milk Mission?
Submit
Should be Empty: