MWC Community Partner Interest Form

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MWC Community Partner Interest Form

Purpose: The Mayors Wellness Campaign (MWC) is seeking to connect with organizations and partners that can support community health initiatives and MWC programs across New Jersey. This form will help us understand your organization’s mission, the resources you can offer, and how we can collaborate. MWCs are often seeking partners to tackle the top health needs of their community and need your support to do so.

Thank you for your time,

The MWC Team

Organization and Contact Information

Organization Name

Name of Person submitting form

Name of Best Contact for MWC

Title/Role

Email Address

Phone Number

Organization Website or Social Media (If applicable)

City/Town and County of Organization's Headquarters

Are you a statewide, regional, or local organization?

Statewide

Regional

Local

Clear selection

Do you already partner with any MWCs?

Yes

Clear selection

If yes, which MWCs?

Areas of Focus & Support

Which health areas does your organization focus on? (Check all that apply)

Mental Health & Substance Misuse Prevention

Food Security and Nutrition

Reproductive and/or Sexual Health

Physical Activity

Chronic Disease Prevention and/or Management

Age-friendly/Healthy Aging

Access to Health Care and Insurance

Housing and/or Homelessness Support

Violence Prevention and Safe Communities

Environmental Health and Sustainability

Preventative Health

Other:

How can your organization support MWCs? (Check all that apply)

Provide educational materials and resources

Offer training or workshops

Sponsor or fund initiatives

Volunteer opportunities

Provide technical assistance or program development support

Offer space for community events

Facilitate networking or coalition-building

Join a local MWC committee

Other:

Does your organization have existing programs that MWCs could benefit from? If yes, please describe. Please feel free to link to your existing programs as well.

Are you open to collaborating with MWCs on new initiatives?

Yes

Clear selection

If yes, what types of initiatives interest you the most?

Additional Information and Next Steps

Would you like to be included in a MWC partner directory?

Yes

Clear selection

Are you interested in attending an upcoming MWC webinar or networking event to explore partnerships?

Yes

Clear selection

Would you be interested in leading or hosting an upcoming MWC webinar or networking event to explore partnerships?

Yes

Clear selection

If yes, please share some details about this (type of webinar etc)

Any Additional Comments or Suggestions

Submit

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