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Organizational Endorsement Form for the Federal "Community Wellness and Resilience Act"
Please complete this form to have your organization included in the list of endorsers of the bi-partisan "Community Mental Wellness and Resilience Act" introduced in the US House by Reps. Paul Tonko (D-NY) and Brian Fitzpatrick (R-PA) and co-sponsors, and in the US Senate by Senator Ed Markey (D-MA) and co-sponsors.
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* Indicates required question
The Name of Your Organization (PLEASE write the name carefully and double check its accuracy before moving to the next question).
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Your answer
Your Name and Title/Role in the Organization: (PLEASE write your name and title here carefully and double check its accuracy before moving to the next question)
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Your answer
Your Email: (PLEASE write your email here VERY CAREFULLY and DOUBLE CHECK its accuracy before moving to the next question)
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Your answer
Your Organization's Website URL (PLEASE write the url here very carefully and double check its accuracy before moving to the next question)
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Your answer
Type of Work Your Organization Is Involved With
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Mental or Behavioral Health
Social Work and Human Services
Disaster Management
Climate Mitigation or Adaptation
Faith or Spirituality
Education
Social, Environmental, and/or Climate Equity and Justice
Child and Family Adverse Childhood Experiences (ACEs)
Neighborhood Wellness and Resilience
Nurses, Physicians, or Other Aspects of Physical Health
Violence Prevention
Drug and Alcohol Abuse Prevention
Other
Other:
Does Your Organization Work at the Nation, Regional, Tribal, State, or Local Community Level, or a Combination of The Above?
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National Level
Regional Level
Tribal Level
State Level
Local Community Level
A Combination of Two or More of the Above
Do You Approve of Your Organization Being Publicly Listed as Endorsing the federal "Community Mental Wellness and Resilience Act of 2023"?
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Yes
No
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