Faith-Based Organizations

Siouxland District Health Department would like to partner with faith based organizations located in Woodbury County, in an effort to improve the health and well being of their members. Example initiatives include: organizing walking groups, health tips/recipes for newsletters, training in CPR, etc. If you are interested in starting or expanding a wellness ministry/program for your members, please complete the following request for information by December 20, 2019. One to two organizations will be chosen annually, based on the responses below.

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* 1. Name of Faith Based Organization

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* 2. Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Number of members

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* 4. Average Sunday Worship Attendance

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* 5. Ethnicity: Please specify the estimated percent of membership for each category. If you don't know or prefer not to say, simply skip this question.

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Unknown/Other

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* 6. Do you currently have a wellness ministry? A wellness ministry is a program that focuses on improving the health of the congregation by focusing on the spiritual, emotional, and physical wellness of your membership. This may include things like adopting a comprehensive tobacco-free policy or providing opportunities for physical activity, nutrition, health education, or screenings.

Yes (please describe your wellness ministry)

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* 7. Are you interested in starting or expanding your wellness ministry?

Yes (please explain why)

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* 8. Do you have a staff or volunteer who is responsible for the wellness ministry or would be interested in getting one started?

Yes

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* 9. Do you currently have an AED (automatic external defibrillator) onsite?

Yes

No, and we are not interested in having an AED onsite

No, but we would be interested in installing an AED onsite

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* 10. If you receive an AED at no expense, would you be interested in holding and paying a minimal fee (approximately $20 per person) for a CPR class to be held onsite for staff and/or volunteers who are frequently in the building?

Yes

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* 11. Do you currently hold events (weddings, funerals, evening activities, community events) at your facility?

Yes

If yes, on average how many days of the week are events held in your facility?