BreastfeedLA-Impact Awards Application
RequiredRequired Question(s)
The purpose of the award is to acknowledge "the best of the best" in our diverse and active lactation community. The name Impact Award was chosen because the word IMPACT resonated in all of our collective goals:
  • To IMPACT breastfeeding rates
  • To IMPACT access to quality breastfeeding education
  • To IMPACT equitable breastfeeding support
  • To IMPACT legislation that affects lactation accommodations and breastfeeding rights
Nominations are limited to Los Angeles County and can include, but are not limited, to Individuals, Clinics, Health Departments, Hospitals, Community Organizations, Private Businesses, Workplaces, Daycare Centers, Schools, Government Agencies and any entity or person you feel is making an impact in supporting breastfeeding.

 
Required 1.
Nominating Person First and Last Name:
 

50 characters left.
Required 2.

Nominating Person Email Address: 

 

50 characters left.
Required 3.

Nominating Person Phone Number: 

 

50 characters left.
Required 4.

Tell us about who you are nominating:

Choose all that apply: 


Workplace
Hospital
Clinic
Individual
Day Care Center
Physician Office
School
Government Agency
WIC
Community Organization
Other  
  • Comment:

  • 500 characters left.
5.
Please tell us more about the person or organization you are nominating: 
(we will not share their information or add them to any mailing lists) 

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:
Department:

Required 6.

Tell us why you are submitting this nomination for BreastfeedLA's Impact Award. 

 

1000 characters left.
Required 7.

What has the individual/organization done to improve breastfeeding? Please be as detailed as possible. 

 

1000 characters left.
Required 8.

What contributions has the individual/organization made to the surrounding community to improve breastfeeding?



 

1000 characters left.
Required 9.
What makes this individual/organization shine when supporting breastfeeding families?
 

1000 characters left.
Required 10.
What else do you want to tell us about this individual/organization?
 

1000 characters left.
Required 11.
What other information would you like to share about the nominee that describes their impact on breastfeeding?
 

1000 characters left.