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Organizational Partner Agreement

Home > JOIN US > SWC Organizational Partner Agreement

Partner Memberships are open to all individuals who represent an organization and are free of charge. The Partner Membership is an agreement for continuous support of SWC, with the idea that the membership will always be filled and can be transferred if needed.

The individual representing their organization has the ability to choose their level of engagement. Level of engagement may be changed at any time by contacting prevention@southsidebh.org.

Only one Partner Membership is required of an organization. If there is more than one representative from your organization, please have them fill out the individual membership form separately.

Name

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

Name(Required)

First Last

Organization(Required)

Title(Required)

Email(Required)

Organization Address(Required)

Street Address City State ZIP Code

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)

Business

Media

School

Youth-serving organization

Religious or fraternal organization

Law enforcement

Civic or volunteer group

Healthcare professionals

State, local, or tribal government agency with expertise in the field of substance use

Service members, veterans & their familes (SMVF)

Other organizations involved in reducing substance use

Not sure - contact prevention

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:

Offer SWC Organizational Partnership to community businesses, agencies, and other organizations that affirm the SWC mission and vision. Individual membership in SWC is open to anyone, including organizational representatives.
Include partner representatives in SWC communications as requested.
Advise SWC Organizational Partners of opportunities to support SWC events and initiatives, including related publicity opportunities. Examples: use of meeting space and/or meeting equipment; distribution of SWC materials; technical or professional expertise; promotional products for SWC event attendees; financial or in-kind contributions for specific purposes.
Post Community Organizational Partners’ names and logos on the SWC Community Partners section of the SWC website (bewellsouthside.org).
Acknowledge Organizational Partners’ SWC contributions through announcements, communications, and publications whenever relevant.

SWC Organizational Partner agrees to:

Affirm support of the SWC mission and vision.
Advise SWC fiscal agent of names/emails of officers, board, or other members to include in the SWC distribution list and update this information at least annually.
Consider distribution of SWC materials to organizational contacts and/or clients to the extent materials align with partner interests.
Consider other means of extending SWC publicity through communication channels such as email communications and social media posts.
Consider resource contributions and/or letters of support to SWC for specific purposes.

By entering my name below, I affirm SWC support on behalf of above-named organization’s leadership.

Name(Required)

Date(Required)

Contact

143 Industrial Parkway Clarksville, VA 23927

434-202-5450

prevention@southsidebh.org

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