FHEC Membership Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in joining the Food & Health Equity Coalition (FHEC) of Essex County!

Please fill out the form below to let us know your areas of interest for participating in the Coalition efforts.

(Your name, organization, and email address will be added to FHEC's member list and shared with other Coalition members. The organization name will be listed on FHEC's website unless you request otherwise.)

Email *

First Name: *

Last Name: *

Name of your organization: *

Your role/title within the organization you represent:
*

Please select which primary sector your organization represents: *

Academic/Research

Business/Private

Community/Grassroots (includes food pantries/food distribution sites)

Education

Government

Healthcare

Nonprofit/NGO

Philanthropic

Other:

FHEC is currently working toward its objectives through Working Groups (WG) and Task Forces (TF). Groups/Task Forces meet monthly and the full membership meets quarterly.

Please select the level of membership you are interested in:

General Member (joins one or more WG/TF, 1 meeting per month per group)

Chair/Co-Chair (leads a WG/TF and participates in Steering Committee meetings, expect 2-3 meetings per month)

Advisory Level Member (high level participation in an advisory capacity, expect 4 meetings per year)

Supporting (receives general quarterly updates but is not involved in the active work of the Coalition)

Other:

Which Working Group(s) do you want to be a part of? (Descriptions and examples of potential objectives are above.) *

1. Transportation Access Working Group

2. Local Food System & Purchasing Working Group

3. Food Access Data & Mapping Team

4. Policy & Advocacy Working Group

5. Community Engagement & Storytelling Team

6. Older Adults Working Group

7. Farm to WIC Task Force (supporting WIC participants to redeem benefits with local growers)

8. FEED (Essex) NJ Task Force (convening FEED NJ awardees to collaborate for maximum impact)

Other:

Required

Any other comments or questions?
Thank you!

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Meeting Essential Needs with Dignity.

Does this form look suspicious? Report

Forms