Prevention Coalition Sign Up
Thanks for your interest in The Norwalk Partnership! We are a coalition of Norwalk, CT community members and organizations working together to prevent substance misuse in youth and young adults. We are looking for caring, committed volunteers representing a variety of stakeholder groups. We ask our coalition members to join our monthly meetings, share their local experiences/data, provide input into our plans, and help with raising awareness and developing strategies. Please tell us more about your interest!
Your Name:
Your answer
Your email address:
Your answer
Personal Background
Please share some information about yourself so that we can create a diverse membership that represents the many cultures of Norwalk.
Gender
Female
Male
Non binary
Prefer not to say
Clear selection
Age Range
Under 18
18-24
25-44
45-64
65+
Clear selection
We are particularly interested in involving members of minority, underserved, or immigrant groups. What racial/ethnic/cultural or other background(s) do you identify with?
Your answer
Interest in Joining Prevention Coalition
Why is substance use prevention important to you?
Your answer
What are some ways you might be able to contribute? (sharing parenting concerns, bringing information to other community groups, gathering data, putting up signs, translating materials, helping with social media, marketing, planning, youth engagement, etc.)
Your answer
What role(s) would you fill on the coalition? (Please check all that apply)
Parent
Teen or young adult
Person in recovery
Leader from a local faith community
Business owner
Member of local youth-serving organization
Member of local civic/volunteer organization
Healthcare representative
Law enforcement representative
School representative
Substance use professional
Media
Local government official
Are you usually available for our meetings on the last Wednesday of each month from 2-3:30pm (via Zoom)?
Yes, usually
Occasionally
No, prefer to be involved some other way
Clear selection
Do you plan to attend our kickoff meeting on September 30th from 2-3:30 via Zoom? (If you're not sure, you can RSVP later to
info@positivedirections.org
to get the Zoom link.)
Yes
No
Clear selection
Please add any other information you'd like to share with us:
Your answer
Please share the name and email of anyone you'd like to recommend to join this coalition. Feel free to share this sign-up form with them:
tinyurl.com/norwalkcoalition
Your answer
Thanks for your time & interest! We'll get back to you soon. Please like & follow our new Facebook and Instagram pages! And watch for TheNorwalkPartnership.org website, coming soon.
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