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New Jersey Prevention Health Education Network
Resource Submission Form

Please submit one form for each resource you are submitting. If possible, please send an email attachment of the resource to njphen@doh.state.nj.us Please fill out this form as completely as possible. If you have any questions about this form, please contact us.

NJ PHEN
Member Organization

Submitter's:

Name:

Phone: - -

Email:

Name/Title of Resource:

Type of Resource:

Curriculum	Video (Running time:)
Lesson Plan	Poster
Brochure	Booklet
Other (please describe):

Topic of Resource: (e.g. safer sex, STDs, Communication skills, etc.)

Target Population:

Description of Resource: (i.e. key messgae, content, etc.)

Are you submitting the actual resource?: Yes No

How can this resource be obtained?

Contact (email, phone, address, web site):
Cost:
Process:

Required Fields

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New Jersey Prevention Health Education Network Resource Submission Form

New Jersey Prevention Health Education Network
Resource Submission Form