The WV Healthy Resources Directory is being developed to assist individuals and groups in finding health professionals in all areas of the state that can provide health-related and educational opportunities, related to obesity, physical activity, and nutrition. If you are a health professional in West Virginia that provides community services such as educational programming, community planning, etc) and would like to have your name and contact information included in this statewide directory, please complete this form, and click submit.

Health Educator Resource

*First Name:		*Last Name:

*Credentials:

*Title:

*Organization/Place of Employment:

*Address:

*City:	*State:	*Zip:

*County:

*Phone:

*Email:

*Professional Title (select one)

*Speciality Areas (choose all that apply)

Nutrition	Physical Activity / Fitness
Weight Management	Other(Please List):

*Services Offered (choose all that apply, you must select at least one)

Individual Counseling	Group Counseling
Conduct Programs / Workshops

*Submitted By (your name):

*Your Email:

Personal Trainer	Cooperative Ext. Service Personnel
Certified Health Education Specialist (CHES)	WV Health Promotion Specialist
Nutrition Outreach Specialist	Other(Please List):