San Diego County Promotores Coalition Membership Application
Are you interested in being a part of a community committed to strengthening health and wellbeing being through community health work?  If so, the San Diego County Promotores Coalition is for you!

Individuals and organizations interested in becoming members of the Coalition are required to complete the following membership application. Applications will be reviewed, and applicants will be notified of the decision in writing within 90 days. Read below for more information expectations, guidelines, commitments and member benefits.

Member Expectations: As a member of the San Diego County Promotores Coalition, I understand and commit to the following expectations.
  1. Active Participation: I will actively participate in coalition meetings and at least one committee, events, and activities, contributing my knowledge, skills, and experiences to promote the mission of the coalition. CHW/Promotores will actively participate in the CHW/P Regional Meetings.
  2. Collaboration & Resource Sharing: I will work collaboratively with other members, partners, and community stakeholders to develop and implement initiatives that address health disparities and promote equity within our communities.I will actively contribute to the sharing of resources, best practices, and lessons learned among coalition members
  3. Commitment to Learning: I will engage in continuous learning and professional development opportunities provided by the coalition, enhancing my skills and knowledge in areas relevant to health promotion, advocacy, and community engagement.
  4. Cultural Competence: I will embrace and respect the diverse cultures, traditions, and backgrounds of the communities we serve, recognizing the importance of cultural competence in effectively addressing health disparities.
  5. Advocacy and Empowerment: I will advocate for the rights and well-being of underserved populations, empowering individuals and communities to become active participants in their own health and wellness.
  6. Coalition Capacity Building: I will share and actively engage in appropriate funding opportunities to support the long term sustainability of the coalition and its activities.
  7. Confidentiality and Ethical Conduct: I will uphold the highest standards of confidentiality and ethical conduct, respecting the privacy and dignity of individuals and maintaining the trust of the community we serve.

SDCPC Commitments: The San Diego County Promotores Coalition agrees to:

  1. Provide a Forum for Collaboration: The coalition is committed to creating an environment that encourages collaboration amongst members, and serve as a liaison to organizations seeking relationships with Promotores/CHWs.
  2. Accountability: The coalition will maintain accountability to all members and will uphold transparency in its operations and decision-making processes.
  3. Inclusivity: The Coalition is committed to being as inclusive as possible in regards to its membership, recognizing the value of diverse perspectives and experiences. 
  4. Professional Development Opportunities: The coalition is dedicated to creating professional development opportunities aimed at increasing the knowledge and skills of Promotores/CHWs within our agencies and community.
  5. Capacity Building Support: The coalition is committed to working with member organizations to increase their capacity and advance the work of Promotores/CHWs within their agencies and the community at large through collaborative resource development and coordinated action.
  6. Centralized Resource and Clearinghouse: The coalition serves as a centralized resource and clearinghouse, providing valuable information and support to Promotores/CHWs and agencies to enhance their professional and practical skills.

SDCPC Membership Benefits: Upon approval members of the San Diego County Promotores Coalition will:

  • Have access to SDCPC member communications
  • Receive preference for SDCPC related funding opportunities
  • Receive early or discounted admission fees to SDCPC events
  • Be invited to special SDCPC events
  • Be listed on SDCPC website
  • Have the ability to chair a committee and be a member of the Coalition Steering Committee

By signing below, I affirm that I have read, understood, and agree to abide by the expectations outlined above as a member of the San Diego County Promotores Coalition. I am committed to supporting the coalition's mission and contributing to its success. By completing this application I also give permission to be added to the Coalition’s mailing list.


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Which Coalition Committee(s) would you be interested in joining? (Please check all that apply) *
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Do you identify as a CHW/Promotor(a)/Representative? *
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I am applying as the following:  *
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Individual Name/Organizational Representative: *
Organization Name (if applicable):
Email Address *
Phone Number *
Why would you like to be a member of the San Diego County Promotores Coalition? *
Signature (typed names will be considered signatures) *
[For organizations] I am authorized to apply on behalf of my organization.
[For individuals] Would you like your name listed as an individual member on public materials?
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[For organizations] Please provide a link to your organization's logo or email it to sdcpcdirector@gmail.com.
Do you grant permission to the San Diego County Promotores Coalition (SDCPC) to use, reproduce, and/or distribute photographs and/or video recordings of you taken during SDCPC meetings and events for the following purposes? 

*Promotional Materials: To promote the activities, programs, and events of SDCPC through printed materials, including but not limited to brochures, flyers, posters, and newsletters.

*Online Platforms: To use on the official website, social media channels, and any other online platforms operated by SDCPC for promotional and informational purposes.

*Media Releases: To provide to local or national media outlets for coverage of the event or related activities organized by SDCPC.

I understand that the images or recordings may be edited, duplicated, or distributed without further compensation or notification.

I release SDCPC, its representatives, employees, and any third parties involved in the creation or publication of the materials from any claims, demands, or liabilities arising out of or in connection with the use of the photographs, video recordings, and/or audio recordings.

I acknowledge that participation in SDCPC hosted meetings and events are voluntary and that I am over 18 years of age.


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