The Community Health Improvement Plan (CHIP) is a community-wide action plan to address five public health priorities determined by a 2012 Community Health Assessment. Any activities impacting these priorities can be included in the CHIP Workplan.

General Information

Please designate one individual to be the primary contact responsible for communicating with HIPMC staff about your group's CHIP activities. A secondary contact person may also be listed if desired.

Question Title

* 1. Lead Contact

Name

Agency

Email Address *

Phone Number *

Question Title

* 2. Secondary Contact (optional)

Name

Agency

Email Address

Phone Number

Question Title

* 3. Which of the following best describes you?

I have already created SMART objective statements for the work I want to submit

I know details about our CHIP related activities, but have not yet created SMART objective statements

I need help identifying specific activities, measures and/or timeframes for our CHIP related work