Community/Organization Partner Registration

Please Provide Your Contact Information

How Would You Prefer to Partner with us?
(Please Select One)

Virtual Food Drive (Fundraiser)

Full Cart Virtual Food Pantry (Virtual Food Distribution)

Host a Hunger Project (Meal Packing Event)

Write a brief description of your organization

1500 characters maximum

What type of impact are you looking to make?

Internal Employee/Associate Engagement

External Community Involvement

Undecided

Where are you looking to make an impact?

Local/Regional Impact

National Impact

Undecided

Please Select your Social Determinants of Health (SDOH) Focus.
Major health promoting factors found in one’s living and working conditions help determine how well individuals live. SDOH are economic and social conditions that influence differences in health status among individuals and groups.

Write a brief description of your organization

1500 characters maximum

Data Sharing Agreement

I agree to the Data Sharing Agreement as presented

What areas of impact does your organization focus on?

1500 characters maximum

Share a description of your organization's desired outcomes and results of your work.

1500 characters maximum

Have you secured a budget for this project

Yes

No, I'd like a Price Quote

Please Provide Some Additional Information about your Event

Projected Date

Do you have any comments or additional questions?

1500 characters maximum

Community Partner Registration Form