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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   

Department of Health

P. O. Box 360, Trenton, NJ 08625-0360
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