DPRP Confirmation Email

Application Received Confirmation Email

Subject line: Diabetes Prevention Recognition Program Application Received

Email Body

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, you will be notified within 30 working days 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 contact the Recognition Program staff at [email protected].

Your DPRP Application Information:

Submission ID:

1. Type of Application:

2. Organization Code: * Assigned Code Not Provided

3. Organization Name:

4. Physical Address:

5. Mailing Address:

6. Web Address:

7. Organization Phone Number:

8. Contact Name:

9. Title:

10. Contact E-mail:

11. Contact Phone Number:

12. Contact Fax Number:

13. Secondary Contact Person Name:

14. Secondary Contract Person Title:

15. Secondary Contact Email Address:

16. Secondary Contact Phone Number:

17. Secondary Contact Fax Number:

18. Data Preparer Name:

19. Data Preparer Title:

20. Data Preparer Email Address:

21. Data Preparer Phone Number:

22. Data Preparer Fax Number (if applicable):

13. Curriculum:

14. Electronic Signature: