Prevention Coalition Sign Up

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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 email address:

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?

Interest in Joining Prevention Coalition

Why is substance use prevention important to you?

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.)

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

Clear selection

Please add any other information you'd like to share with us:

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

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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