1. Proposed Date for message to go out (required)
Please share the date that you would like the message to be delivered. Note, this date may fluctuate if we have multiple requests from community partners.

2. Is your message send date flexible? (required)

YesNo

3. In English, write out what you would like your message to say that is promoting the free (or reduced rate) program/activity/service.
Tips: be creative, consider the tone of the message, what would capture the attention of the subscriber? Remember, messages must be 140 characters or less.

4. If possible, translate your message into Spanish.
DO NOT USE GOOGLE TRANSLATE. Remember, it must also be 140 characters or less. (If you are not able to translate, we will handle translating the message into Spanish. Optional.)

5. What event link would you like to include in this message so families can access more information about the program/activity/service/etc.? This is required for all submissions
Note, this is the responsibility of your organization to manage this link with up-to-date information. This will include altered times/dates/locations/weather related changes. Please do not send a bit.ly link; copy and paste the full URL. (Required)

6. Identify the minimum age that the message should be delivered to.
Note,earliest is to a mother in their 3rd trimester. (Required)

7. Identify the maximum age that the message should be delivered to.
Oldest age is 8 years. (Required)

8. Specify if the program/activity/service/etc. is for a specific zip code area, or if it can be distributed to the entire distribution list. (Required)

9. Who should be the point of contact for follow-up needed on this message?