Kansas Hospitals and Birth Centers:
Please use this online form to apply for your annual renewal (self-assessment) of High 5 for Mom & Baby recognition. Facilities following all ten of the High 5 practices will receive High 5 for Mom & Baby Premier recognition at renewal.
Facilities new to High 5 for Mom & Baby can use this form to apply for initial recognition.
To preview the forms (pdf) before completing online you may view the annual renewal (self-assessment) form here or the initial application form here.
If you have questions about High 5 for Mom & Baby or the application process, please contact program coordinator Gwen Whittit at firstname.lastname@example.org.
Thank you for your commitment to helping ensure successful breastfeeding for moms and babies!