Att 4d - Application confirmation email

Attachment 4D - Application Confirmation Email.docx

CDC Diabetes Prevention Recognition Program

Att 4d - Application confirmation email

OMB: 0920-0909

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Thank you for your application to the Diabetes Prevention Recognition Program (DPRP). If you indicated that you will be using the National Diabetes Prevention Program Curriculum, you will be notified within 15 working days regarding the outcome of your application.

If you indicated that you will be using an alternative curriculum, please email the curriculum as a PDF or Microsoft Word attachment to [email protected] within 10 working days. If you are submitting an alternative curriculum, you will be notified within 30 working days from receipt of the curriculum by the DPRP regarding the outcome of your application.

The information that you provided in your application is reproduced below. If you wish to correct an error or withdraw your application, or if you have any other questions about your application or the DPRP, please call the Centers for Disease Control and Prevention’s helpline at 1-800-CDC-INFO (1-800-232-4636), TTY: (888) 232-6348 available 24 hours every day. Please ask the help desk staff for information about applying to the Diabetes Prevention Recognition Program. You may also send an email to [email protected] with the subject line “Diabetes Prevention Recognition Program Application.”

Your DPRP Application Information

1. Type of Application: Change

2. Organization Code: *1234567890

3. Organization Name: Diabetes Group Program

4. Physical Address: 123 Healthy Way, Baltimore, Maryland, 21217, 0000

5. Mailing Address: No Mailing Street Address Selected, No Mailing City Selected, No Mailing State Selected, No Mailing Zip Code Selected, Mailing Zip Plus 4 Not Selected

6. Web Address: www.diabetes-group-program.org

7. Organization Phone Number: 410 555 5555

8. Contact Name: Mr. Bratton, James, MA

9. Title: Lifestyle Coordinator

10. Contact E-mail: [email protected]

11. Contact Phone Number: 410 555 5555

12. Contact Fax Number: 410 555 5555

13. Curriculum: National Diabetes Prevention Program Curriculum

14. Electronic Signature: James Bratton, Lifestyle Coordinator, Diabetes Prevention Group, 6/22/2011

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorJames Bratton
File Modified0000-00-00
File Created2021-01-31

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