Submit Your Community Organization

In order to create a community inventory please fill out the following form.

All fields are required.

Coalition/Organization/Group Name

Address

City, State, Zip

Parish [District]

Contact Person

Phone

Title/Role At Organization

Email Address

What kind of group are you?
Advocacy
Community Health
Education
Faith-based
Foundation
Government
Healthcare
Other (Please Specify)

What issues does your group work on?
Abuse/Violence
Advocacy/Policy
Social Services
Cancer
Community Development
Disability
Elderly
Healthcare
Literacy
Mental Health
Obesity
Sexual Health
Substance Abuse
Maternal Health
Tobacco
Youth Development
Other (Please Specify)

What are your group's major strengths? What are you good at?
Community Support
Education
Facilities
Funding
Leadership
Networking
Program Development
Staff
Teamwork
Technology
Training
Other (Please Specify)

What sort of resources or technical assistance, if any, could you use to improve your effectiveness and success?