EmailMe Form - Request for Community Nutrition Educator Service

Contact person *

First Last

Name of organization *

Address *

Postal code *

Telephone number *

### - ### - ####

Email address (Do not enter any spaces after the full address is entered) *

How did you hear about the CNE program? (check all that apply)

You are able to request a CNE for an in-person or virtual session. Which option are you requesting? Choose only one option. *

In-person

Virtual (e.g.. Zoom, GoTo Meeting, Microsoft Teams, etc.)

Details for in-person service request:
Location, if different from the address listed above:

Is well-lit parking available?

Yes

No

Location of parking and cost, if applicable:

For in-person options: please provide details about any protocols and procedures that you may have in place for COVID-19 safety guidelines. (For example: physical distancing, hand washing/sanitizing, mask use, etc). If none, you may leave this section blank.

Details for online/virtual service request:
Agencies are responsible for organizing the online platform. What platform will you be using? Provide any other relevant details.

Date(s) of service required:

If you are requesting more than one date, please indicate additional dates in the text box below. *

MM / DD / YYYY

Duration of the session (For example, 2:30-3:30 p.m.) *

Additional dates and comments:

Was the topic selected by the community members/group? *

If no, who selected the topic?

Why do you think this topic is needed? Please specify. *

Number of people expected (minimum of 4 people required): *

Agency staff are encouraged to attend; will staff be in attendance? *

Yes

No

Age range *

Other characteristics (check all that apply):

Parents/caregivers

Newcomers (newcomer nutrition programs and presentations are available at: https://www.icmanitoba.com/services/nutrition/)

English as an additional language

Visual impairment

Hearing impairment

Other

Type of service requested (check one): *

Presentation

Food demonstration (not available virtually)

Presentation and food demonstration (food demo not available virtually)

If a food demonstration has been requested, is the following available? (check if yes)

Kitchen facilities with sink

Cooking and serving utensils

Select an interactive presentation and/or activity per date requested. If a presentation and activity are requested, we recommend choosing a combination from the same theme. Presentations and activities can be selected on their own if time is limited. Allow approximately 30-45 minutes for the presentation and an additional 30-45 minutes for most activities.

Theme #1: Canada's Food Guide/Healthy Eating

Presentation: Eat Well. Live well. Canada's Food Guide (30-45 minutes). A review of Canada's Food Guide and basic information on healthy eating.

Select an activity from the Canada Food Guide/Healthy Eating theme #1.

Theme #2: Food Systems

Presentation: Food Connections from Land to Plate (30-45 minutes). Information on where food comes from and ways that we can eat to keep the planet and people healthy.

Select an activity from the Food Systems theme #2.

Theme #3: Healthier Grocery Shopping

Presentation: Five Steps to Healthier Grocery Shopping (30-45 minutes). Information on making healthier choices at the grocery store.

Select an activity from the Healthier Grocery Shopping theme #3.

Theme #4: Relationships with Food

Presentation: Beyond Nutrition - Joy and Meaning Through Food (30-45 minutes). A facilitated discussion on how to keep or bring back the joy of eating.

Select an activity from the Relationship with Food theme #4.

Theme #5: Cooking Basics

Presentation: Cooking Basics (30-45 minutes). Highlights the basic knowledge needed to prepare meals at home including menu planning, food safety, basic food staples and equipment needed for food preparation.

Select an activity from the Cooking/Food Skills theme #5.

Food Demonstrations
*NOTE: not available virtually

Allow approximately 30-45 minutes for a food demonstration. Groceries will cost approximately $15-$20 per recipe (6-8 servings), and are the responsibility of the agency. A basic set of kitchen equipment is required. Food demonstrations can be included with any of the above interactive presentations and supporting activities.

Green pear smoothie (blender required)

Broccoli salad

Couscous salad

Southwest baked bean soup (stove-top required)

Quick and easy lentil tacos (stove-top required)

Comments

Please add any additional details for your request. If more than one date was requested, please specify date for each selected presentation, activity or demonstration.

Su	Mo	Tu	We	Th	Fr	Sa
		1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19
20	21	22	23	24	25	26
27	28	29	30