SWC Member Agreement - Southside Wellness Coalition

Facebook

This field is for validation purposes and should be left unchanged.

Name(Required)

Email(Required)

Organization(Required)

Title(Required)

Address(Required)

Phone #1(Required)

Is this phone number:(Required)

Cellphone

Work phone

Home phone

Phone #2

Is this phone number:

Cellphone

Work phone

Home phone

I am interested in SWC involvement because ...(Required)

Talents, skills, and resources I and/or the organization I represent may offer SWC(Required)

(ex: professional or technical expertise; boost publicity and events promotion; financial support or in-kind match for grant funding; access to relevant data; volunteer time)

What can SWC do to help you and/or the community group(s) or organizations you are involved with?(Required)

Community sectors I am part of:(Required)

Level of Engagement

Level 1 General Membership: ability to vote, attend events/table, share and receive information, attend meetings, complete surveys/interviews on behalf of the coalition

Level 2 If you choose Level 2, you will also be asked to choose your preferred work group from the list below.

Provide Information Table/attend events, participate/choose campaigns, take pictures & write narratives for social media posts, share posts on private and public accounts, trauma-informed work.

Data Collection Conduct interviews with key stakeholders, proctor surveys, and outreach to local businesses, organizations, and leaders to join the coalition

Choose Your Level of Engagement

Level 1

Level 2

Level 2 Work Group

Provide Information

Data Collection

Southside Wellness Coalition agrees to:

Facilitate development and adherence to SWC by-laws and policies.
Oversee development, implementation, and ongoing evaluation of strategic action plans that advance the SWC mission and vision.
Ensure compliance with the terms and reporting requirements of all funding sources, including documentation and secure storage of SWC records.
Pursue a credible and relevant sustainability plan which includes financial, material, volunteer and in- kind resources.
Support member development with opportunities to network, learn, and participate in SWC activities and coalition development.
Respect the rights of SWC members to hold their own opinions and beliefs.

SWC Member agrees to:

Support SWC values by acting as a role model for youth, families, and peers.
Participate in SWC development, strategic planning, and activities through SWC meetings (held monthly), Work Groups, and special events. Maintain familiarity with SWC through the SWC website and other member communications.
Share SWC materials, social media posts, and event promotions through personal contacts and community or organizational groups as relevant.
Document SWC time and contributions as match for grant funding as allowed.
Renew and update the SWC membership form at least annually.

By entering my name below, member acknowledges email will be added to SWC emails, and that email and phone # may be shared with SWC members and others for SWC mission related communications. Member name, and affiliate organization if provided, will be published on the SWC website and within other SWC communications. Contact information will not be otherwise shared by SWC without separate permission.

Name(Required)

Date(Required)

Individual Membership

Contact