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Membership Form

CORE Membership Form

Our Mission: We are a non-profit coalition bringing racial equity to mental health supports for people of color through innovative community collaborations.  Our vision is:  Healthy Lives, Whole Communities. Our principles are:   inclusive, transparent, responsive and nimble, mindful, equity operationalized, giving voice.  
Our priorities are mental health and racial equity.
1.Individual's Name
2.Organization or Coalition Name
3.Address
4.Telephone
5.Website
6.Primary e-mail contact
7.Organizational Mission
8.If this is an organization/ coalition membership, list leadership/management point person (name/title)
9.What type of organization or role you represent in the community?
10.Title
11.Email
12.Telephone
13.Race/Ethnicity
14.Preferred Gender Pronouns
15.Please include any comments here.
Current Progress,
0 of 15 answered