Membership Application

Sussex County Health Coalition (SCHC) membership is free and allows you to receive SCHC updates, community-based e-newsletter and be eligible to chair SCHC sub-committees. SCHC members can also submit their organization’s information, events or needs to Committee leaders to share with our network of committed, mission-driven membership body of over 500 individuals.

A downloadable Word Document is available by clicking the below link or simply fill in the information below. If you have questions about this application or the process, please mention it in the comment section below or contact us at info@healtysussex.org.


APPLICANT INFORMATION    
 
 
 
 
 
 
CURRENT EMPLOYER    
 
 
 
 
   
 
COMMUNITY VOLUNTEER / INVOLVEMENT INFORMATION
Are you a DANA Member?   YES     NO
 
PLEASE CHECK WHERE APPROPRIATE
Indicate below by checking the box the committee's structure you are currently involved with.

General Membership
Definition of a general member is one who is interested in the SCHC and attends some meetings when able and wants to receive information but does not serve on a committee.

  

Steering Committee
Definition of a steering committee member is one who attends a majority of meetings and is a member of a specific committee that meets on a monthly basis.

  

Chair/Co-Chair Committee
Definition of a Chair or Co-Chair is an individual who leads or co-leads a specific committee and who helps the Executive Director lead the coalition. S/he may or may not hold a role on the Executive Committee.

  
 
WHAT COMMITTEES DO YOU SERVE ON?
Executive   Steering
Youth Serving / Community   Coalition Volunteer
Behavioral Health Task Force   Resources Development / Media
Early Learning / Child Care   Health Committee
Sussex SUCCESS Team    
 
WISH TO SERVE ON A COMMITTEE BUT ARE NOT ASSIGNED TO ONE
Committee Name(s)   Would you like to serve in a leadership capacity?
  YES     NO
  YES     NO
 
SUGGESTIONS OR SPECIFIC NEEDS YOU MAY HAVE
I have kept a copy of this application and am fully aware of the Mission and Vision of the Sussex County Health Coalition. I agree to assist the Coalition with working towards that mission and vision. I recognize that I do not speak for the entire Coalition but will act in good faith with regards to promoting the Coalition. I also am aware my information will be used solely for SCHC and not shared with others. I agree that all photography at meetings and events may include my image and give permission for that use. I agree to allow my name and organization to be posted on the SCHC website.
 

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