Westport Prevention Coalition - expression of interest
Thanks for your interest in the Westport Prevention Coalition, a part of Westport Together! We are a  group of Westport 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 all our work, and help with raising awareness and developing strategies. Please tell us more about your interest!
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Your Name:
Your email address:
Personal Background
Please share some information about yourself so that we can create a diverse membership that represents the breadth of our community.
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Age Range
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We want to ensure involvement from all members of our community, including immigrant, minority or underserved 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 local concerns, bringing information to other community groups, gathering data, hosting events, 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)
Are you typically available to meet on the 1st Tuesdays of the month?
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In addition to our monthly coalition meeting, would you be interested in a working group to plan around specific topics? (occasional 1/2-1 hr meetings per topic)
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Which topics should we present on during upcoming coalition meetings to share current and local information? (These would be brief presentations to update/educate COALITION MEMBERS to support prevention work)
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Which topics do you think our COMMUNITY most needs information about?
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Which topics do you think our COMMUNITY most needs information about?
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Please let us know if there's anyone we should reach out to who might like to be involved. You can also share this sign-up form with others: www.tinyURL.com/westportcoalition 
Please add any other information you'd like to share with us:
Thanks for your time & interest! We'll get back to you soon. Please like & follow Westport Together on Facebook and Instagram!
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