Building State Capacity for Integration Learning Collaborative:Core Project Team Member Commitment Affirmation Survey

This is the core project team member commitment affirmation. Each of the three core project team members are required to complete it by 11:59 p.m. ET on Wednesday, July 1, 2026.
The project team lead must complete the project application.

The Building State Capacity for Integration Learning Collaborative (LC) will run from October 2026 through January 2028.

Please review the responsibilities and expectations in the project overview. Participation in the LC is a team-building opportunity. During the LC, project teams will need to meet on their own and share with other teams to exchange ideas and learn from each other.

Contact Sarah Kolo, sk22@georgetown.edu, for assistance.

1.Core Project Team Member(Required.)

Name, credentials:

Organization name:

Title:

E-mail address:

Phone number:

2.By submitting this form, I commit to my role as a core team member and my intention to:(Required.)

Help complete the Capacity Inventory for Integrating Oral Health Care into Primary Care for Pregnant Women.

Provide input to develop project aim statements and state-level improvement action plans to facilitate integrating oral health care and prenatal care.

Make time to work in partnership with the core team and additional partners, as needed (in meetings and via e-mail).

Participate in eight 1-hour all-project team webinars that will be held on the third Tuesday of every other month from 1:00 to 2:00 p.m. ET. Webinars will be held in October and December 2026, February, April, June, August, and October 2027, and January 2028.

Participate in seven 1-hour individual project team coaching calls that will be held with the consortium every other month. Calls will be held in November 2026, and January, March, May, July, September, and November 2027.

3.I’ve read the project overview and required activities and agree to participate fully in the learning collaborative. (Type name and date.)(Required.)

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an annual award totaling $1,700,000 with no funding from nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, or endorsement by, HRSA, HHS, or the U.S. government. For more information, please visit www.HRSA.gov.