Fillable My Healthy Northport The Purpose of My Healthy (Incorporated Village of Northport, NY)

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My Healthy Northport The Purpose of My Healthy (Incorporated Village of Northport, NY)

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U.S.A. forms for Incorporated Village of Northport, NY

BROWSE INCORPORATED VILLAGE OF NORTHPORT, NY (NY) FORMS

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Idea Submission for
“My Healthy
Northport”
My Healthy Northport
The Purpose of “My Healthy Northport” is to optimize the potential of all Village residents, families, employees,
and businesses. Success is achieved through the ongoing development and delivery of meaningful
programming that supports the well-being of our community in the following ways: Emotional, Spiritual,
Physical, Intellectual, Financial, Educational, Social, Occupational, And Environmental.
…
While all applicants are welcome to apply, Village residents and businesses will be given priority in the review
process.
Personal and/ Or Business Information
Name
Business Street
Address Including
City, State, and ZIP
Code
Business Name
Email Address
Phone Number
About the Program
Program purpose:
Program
Description:
Date(s):
Maximum # of Attendees:
Time(s):
Location of the
Program:
If series, How Many Classes in the
Series?
(circle one)
One Class or Series
Page 1 of 2
o
Required Documents
License:
Insurance:
Marketing Plan:
Certification:
Agreement:
Malpractice:
Identification :
Signature
Name
Signature of the Person Submitting this Form
Name of the Person Submitting this Form (print)
Date of Signature
MM
DD
YY
____________________________________________________________________________________________
Approval Section
Concept
Approved?
Funding
Approved?
Date Resolution Adopted by Board of Trustees
Date Agreement was executed:
Signature Signature of Board Member Print Board Member
Page 2 of 2
/ / 20_____
/ / 20_____
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My Healthy Northport The Purpose of My Healthy (Incorporated Village of Northport, NY)

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Completed 14 July 2020

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