• 21-Day Plant Powered Jumpstart Registration

    Fall 2026

  • Plant Powered Metro New York (PPMNY) is excited to welcome you into our 21-Day Plant Powered Jumpstart! This comprehensive program is designed to introduce you to evidence-based principles of plant-based nutrition and provide you with support to make substantial dietary change for health and healing.

    Please complete this registration form no later than Tuesday, October 6th. Note that by registering for this program you are communicating your readiness to adopting the dietary guidelines of a whole food, plant-based diet for 21 days.

    For further information, visit https://plantpoweredmetrony.org/jumpstarts/. Please direct any questions to jumpstart@ppmny.org.

  • Format: (000) 000-0000.
  • Date of birth*
     / /
  • What race or races do you consider yourself to be (select one or more)?
  • How did you hear about the Jumpstart?*
  • Which platform or social media channel?*
  • Have you participated in a 21-Day Plant Powered Jumpstart before?*

  • Motivation & Ability

  • What are your top 1-3 reasons for joining the Jumpstart program?*
  • These are the dates of our live virtual sessions (all noted in Eastern Time). Please let us know which sessions you will be able to attend live. Note that attendance is strongly encouraged for ALL sessions, though recordings will be available. If Jumpstart interest exceeds capacity, PPMNY reserves the right to defer your participation to a future program if you are available to attend fewer than half of the sessions live.*
  • PPMNY will provide in-person tours of local farmers’ markets or grocery stores on Saturdays and Sundays, October 17, 18, 24, and 25, at locations around the metro area, depending on participant interest and tour leader availability. Specific locations and times will be announced during the program. If you are local to the metro area, please indicate where you would be most likely to attend a market tour. You may choose more than one location.

  • Mentorship & Support

  • All Jumpstart participants will be assigned to a small group of 6-10 participants who are supported by 1-2 Lifestyle Mentor(s) from the PPMNY community. Please select your top 1-3 mentorship themes from the list so we can group you with people who have similar interests or experiences. The themes offered below are based on our Mentors’ experiences. We will confirm your mentorship assignment before orientation.*
  • Mentorship groups have dedicated meetings three times during the program on Tuesdays, October 13, 20, 27. You will be assigned to a mentorship meeting taking place at either 12 PM or 7 PM ET (not both). Select your preferred time for these meetings, or check both if you could attend at either time.*

  • About Me & Food

  • How comfortable are you with preparing your own meals?*
  • Approximately how many times each week do you prepare your own meals for lunch and dinner?*
  • Select whichever option below best/most closely describes how you currently eat.*

  • Medications & Health Questions

    The information in this section is being collected to ensure participant safety and will only be used by PPMNY's jumpstart leaders and our medical partners. We request your honest disclosure. By answering these questions you affirm that they are true; please do not withhold information. **If you are on medication for diabetes or hypertension (high blood pressure), we require you to attend one of two identical webinars with one of our medical partners. The webinars will be offered prior to orientation using an anonymous interface so that no other participants will know who is attending, and all questions will be posted anonymously. In addition, it is essential that you work with your personal physician to monitor your medications over the course of the program; if you follow the jumpstart's dietary guidelines closely, you may need to reduce your dosages.
  • Have you been diagnosed with diabetes and/or hypertension? If you do not need to participate in the webinar, you can skip to the next page.
  • Are you on any medications for the above condition(s)? Check any that apply.
  • Do you have a primary care physician, or do you see a specialist who supports your medical care and/or medications/dosing?*
  • Please select a time to attend a webinar with one of our medical partners. We expect they will last about 30-45 minutes.*

  • Final Thoughts & Waivers

  • To complete the enrollment process, you must read and agree to the following forms.

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