Food Safety Education and Training Materials Sharing Form (Business Profit/Non Profit)

Food Safety Education and Training Materials Sharing Form

NAL - FSMaterialsSharingForm_Final_10 23 10

Food Safety Education and Training Materials Sharing Form (Business Profit/Non Profit)

OMB: 0518-0046

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Food Safety Educational and Training Materials Submission Form



Contact Name: ___________________________________________________________


Contact Phone:___________________________________________________________


Contact Email:___________________________________________________________



Resource Title: ___________________________________________________________


Producer Name: ____________________________________________________


Producer Contact Information:

Street Address: _____________________________________________________

City/State/Zip: _____________________________________________________

Telephone: ________________________________________________________

Fax: _____________________________________________________________

Email: ___________________________________________________________


Year Published: ___________ Revision Date: __________ Edition: ____________


If this resource is available online, please provide the Web site address (url):


________________________________________________________________



Briefly, describe your resource:





What is the target audience(s)?

(To select more than one, hold down CTRL key while selecting):




What format(s) is the education material available?

(To select more than one, hold down CTRL key while selecting):




What topic(s), if any, describes the education material?

(To select more than one, hold down CTRL key while selecting):



Is it available in a Non-English Language(s)?

(To select more than one, hold down CTRL key while selecting):




What is the cost of the material (price/unit)? If item is “free” please specify.


_________________________________________________________



Can this material be ordered in quantity?


Yes___ No____


Describe any bulk discounts available:





Please indicate how this material may be used by other educators:

___ May copy for educational purposes without prior permission

___ Permission needed to copy

___ May not copy


How can this item be ordered or accessed?


Online (List url):______________

Printable Order Form (List url):__________________

By Phone: ____________

By Fax: _______________

Email: ________________

Free Download (List url):_____________________


Was this Education Material funded by a Grant?


Yes: ________ No __________

If yes, please specify:


Funding Agency:­­­­­­­­­­­­­_______________

Grant Number:_______________

Project Number:______________



Additional Comments or Information about this Education Material:



According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to a collection of information unless it displays a valid OMB number. The valid OMB control number for this information collection is 0518-xxxx. The time required to complete this information is estimated at 11 minutes per response due to the averaging of check boxes and text fields.



File Typeapplication/msword
File TitleFood Safety Educational and Training Materials Submission Form
Authorjliu
Last Modified Byyvette.anderson
File Modified2010-10-25
File Created2010-10-25

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