Hanover Cares Coalition Member Application
Thank you for your interest in Hanover Cares! Please complete this brief application.
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First and Last Name *
Phone Number *
Email Address *
Mailing Address *
Organization (Put N/A if not applicable) *
Of the 12 community sectors described below, to which do you belong? Check all that apply. *
Required
What is your race/ethnicity? Please check all that apply. *
Required
Do you identify as Hispanic/Latinx? *
What is your age group? *
What is your gender? *
What is your preferred method of contact? Check all that apply. *
Required
Do you want to opt in for text messages updates? If so, please provide your cell phone number below.
Which committee would you be interested in serving? Please rank the committees by first, second, and third choice. *
First Choice
Second Choice
Third Choice
Fourth Choice
Hanover Business Cares
Community Education and Outreach
Youth Engagement
Opioid Taskforce/Community Response
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