Bucks-Mont Trauma Coalition Sign-Up Form Coalition membership connects individuals and organizations committed to strengthening trauma-informed resources and services in our region.Free membership includes: Optional quarterly learning/sharing meetings Directory listing on the Bucks-Mont Collaborative website Sharing resources with the community throughout the year, and Receiving coalition emails throughout the year Question Title * 1. Your Contact Information: Question Title * 2. Are you joining as an individual, organization, or both? Membership is free and open to all. Individual Organization Both Question Title * 3. What trauma resources and/or trauma-informed services does your organization provide the clients you serve? Please check all that apply. Clinical and Therapeutic Services Crisis and Safety Supports Case Management and Navigation Advocacy and Legal Resources Medical and Forensic Resources Community-Based and Peer Supports Workshops and Trainings Youth and School-Focused Supports Accessibility and Service Delivery N/A Other (please specify) Question Title * 4. Please provide any clarifying or additional information regarding your response to question #3. Question Title * 5. What trauma resources and/or trauma-informed programs or services does your organization provide to other professionals? Tools, Resources, and Materials Training and Workforce Development Consultation and Technical Assistance Supervision and Support Medical and Forensic Resources Community-Based and Peer Supports Cross-Agency Collaboration Specialized Program Support Research and Evaluation N/A Other (please specify) Question Title * 6. Please provide any clarifying or additional information regarding your response to question #5. Question Title * 7. Is there a preferred contact at your organization for trauma resource or service requests? N/A if you are the preferred contact and completed question #1. Question Title * 8. Please share any additional information or questions here. Or, contact the Bucks-Mont Trauma Coalition Coordinator, Sherry Wherry: sherry@bucksmontcollab.org. Done