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HEAL PA Interest Form
Please complete this form to indicate your interest in participating in HEAL PA's activities.
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Your Name
*
Your answer
Your Email Address
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Your answer
Your Organization (if applicable)
Your answer
Your county/region
Your answer
What about HEAL PA’s purpose of supporting Pennsylvania in becoming trauma-informed and healing-centered resonates most with you?
Your answer
Thinking about the communities with which you interact, what trauma-informed efforts or initiatives do you see already happening? This might include efforts within the community itself or within the systems and organizations that serve it.
Your answer
Continuing to think about the communities with which you interact, where do you see opportunities for trauma-informed efforts?
Your answer
Looking ahead 3–5 years, if efforts to build trauma-informed and healing-centered communities are successful, what measurable outcomes would you hope to see in the communities where you live and/or work?
Your answer
Which sector(s) do you interact with regularly and/or about which you have insight?
(You may select as many as you wish.)
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PK-12 Education
Higher Education
Healthcare
Behavioral Health
Substance Use and/or Harm Reduction Services
Criminal Justice System
Civil Legal System
Child Welfare
Faith Communities
Housing Services
Government/Policy
Community Based Organizations
Workplace/Business Sector
Cross-Sector Coalitions
Other:
Required
What level(s) of involvement in HEAL PA would be of interest to you? (You may select as many as you wish.)
Information Sharer: I can help distribute opportunities and resources about trauma-informed, healing communities within my networks.
Idea Contributor: I can generate ideas and offer input about upcoming opportunities, projects, initiatives by participating in things such as focus groups and interviews.
Connector: I can help with networking, relationship building, and introductions across sectors to help foster partnerships.
Committee/Working Group Member: I’m interested in actively participating in a committee and/or working on longer-term projects.
Donor/Funder: I’m interested in funding the work, or certain elements of the work, at a community and/or statewide level.
Other:
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