Basic Coalition Info

As part of the Alliance of Coalitions for Change (AC4C) being awarded the Drug Free Communities (DFC) Support grant, the needs of coalitions are being assessed across the state. This will allow AC4C to develop and provide resources to meet local coalition needs and focus on a broader vision for the state. Thanks for your time!

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* 1. What is the name of your coalition

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* 2. What county (counties) does your coalition serve? (If Applicable)

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* 3. What is the approximate population of the county (or counties if applicable) your coalition serves?
If counties- please list individually with populations

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* 4. What city (cities) does your coalition serve? (If applicable)

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* 5. If you just cover a city and not an entire county please let us know the population of the city (cities)
(If you answered the question about county population you do not need to answer this question)
If listing multiple cities please list them individually and provide the population.

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* 6. Coalition mailing address, phone and email

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* 7. Coalition Website- If you have one.
By providing this information you give AC4C permission to link your page to our website.

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* 8. Do you have a facebook page?

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* 9. Are you interested in receiving the monthly roundtable which includes information about training opportunities, scheduled meetings and events, and other important information.

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* 10. If you are interested in receiving the roundtable, please share your email.

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