Lane County Violence Prevention Coalition (PACT) Interest Form

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Name & Pronouns

(ex. first last, they/them)

Preferred email:

Availability:

Currently, PACT meetings are the second Tuesday of every month from 2-3:30 pm. Is this a timeframe you can commit to on a regular basis?

Yes

Other:

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What organization will you be representing as a member of the PACT? (What organization do you currently work for?)

(ex. Center for Childhood Safety and Wellbeing )

Please share who we can contact at your organization (supervisor or other) in case your membership changes and we are no longer able to contact you.

Do you have experience in primary prevention work? Please explain below your experience in prevention work.

HERE is a link to how we define primary prevention

The PACT has a commitment to anti-racism and equity in the way that we lead our work as well as the environment that we foster in this coalition. Do you agree to continue to this commitment as a member?

Yes

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How did you hear about the PACT?

Submit

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