Please use this form to tell us about tobacco prevention programs and policies on your campus. We may use the information to develop a case study brief or to keep track of the numbers and types of programs and policies being implemented across the country. Please give us as much information as possible. We may contact you for clarification or additional information.

* Required fields
* Campus Name:
* Campus Location:
  Campus Enrollment:
  Suggested name or descriptive title of the program or policy:
 
  Briefly describe the program or policy:
 
  When was the program or policy implemented?
 
  What were the goals of the program or policy?
 
  How was this program or policy implemented? Who led the effort?
  Who was involved?
 
  What costs were associated with the program or policy?
 
  What are your future plans for continuing this program or policy?
 
  Is there a website that describes your program or policy?
 
  Additional information:
 
* Your Name:
  Your Job Title:
  Campus/
  Organization:
* Phone:
* Email:
 

 

 
 
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