Application to Join the Coalition for Whole Person Health 
About the NCCIH Coalition for Whole Person Health
This application is for eligible organizations to apply for membership in the National Center for Complementary and Integrative Health (NCCIH) Coalition for Whole Person Health. The NCCIH Coalition for Whole Person Health is an independent coalition, national in scope, that is comprised of US-based nonprofit organizations. For profit organizations and government agencies are not eligible at this time. However, mechanisms for Coalition engagement with these entity types are being examined. These organizations raise awareness about NCCIH, the National Institutes of Health (NIH) and the importance of furthering research on integrative, interprofessional, patient-centered, and whole person care. They are key stakeholders of the NCCIH and serve as the voices of the patients, communities, and professionals for whom NCCIH works. NCCIH is 1 of 27 institutes and centers in the NIH and is the lead agency for scientific research on complementary and integrative health approaches. More information about the NCCIH Coalition for Whole Person Health can be found here: https://www.nccih.nih.gov/about/partnerships/nccih-coalition-for-whole-person-health

Coalition Membership Criteria
Eligible 501(c)3, 501(c)4 and 501(c)6 organizations should demonstrate an engagement with the NIH and/or NCCIH and/or on-going support for NIH and NCCIH mission, vision and strategic plan. For example, your organization could have applied for and/or received a NIH and/or NCCIH grant, had a speaker from NIH or NCCIH, have had someone from your organization be on the Advisory Council or review grant applications, or provided feedback (or input) to the NIH or NCCIH on proposed strategic plans, etc. In consultation with NCCIH, a Steering Committee of the NCCIH Coalition for Whole Person Health reviews eligibility of applicants. Please insert the email address below that you would like a copy of your application responses sent to.
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Today's Date: *
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Full Legal Name of Organization: *
Primary Organization Contact/Representative: 

(Note: due to limited administrative resources for the Coalition, there can be only one contact/representative per organization member)
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Representative Credentials:
Representative Title/Role: *
Representative Email Address: *
Representative Telephone Number: *
Organization Website Address: *
Organization Mailing Address:  *
Organization Mailing Address Continued (optional)
City: *
State: *
Zip Code: *
Non-Profit Status:  *
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Type of Nonprofit Organization (check the primary category, only one): *
Required
Areas of Focus (check all that apply): *
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Organization Mission & Vision:  *
Please write no more than 250 words on how your organization meets the NCCIH Coalition for Whole Person Health membership criteria described above:
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What is your organization's primary reason for wanting to join the NCCIH Coalition for Whole Person Health? 
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If you have the following social media platforms, please include a link to your page/account in the fields provided below:


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Other (please list and link all):
Do you have a newsletter or more than one newsletter? Please list newsletter(s) and audience(s) for each (e.g. 1) Members Newsletter, audience: 2) Conference Newsletter, audience: past conference attendees, etc.). 
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