REGIONAL SHAC REGISTRATION FORM
Meeting will be held on April 23, 2024, from 5- 6:30 pm, at the EPISD PDC building.
Name
First Name
Last Name
District or Community Organization
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
I am most interest in
Please Select
Child Nutrition
Physical Activity/ Education
Mental Health / SEL
Health Services / Nursing
Vaping / Tobacco Prevention
Other
If you choose "other", please list below
Submit
Should be Empty: