Prevention Coalition Sign Up

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Thanks for your interest in The Norwalk Partnership! We are a coalition of Norwalk, CT community members and organizations working together to prevent substance misuse and promote wellness in youth and young adults. We are looking for caring, committed volunteers representing a variety of stakeholder groups. We ask our coalition members to join our monthly meetings, share their local experiences/data, provide input into our plans, and help with raising awareness and developing strategies. Please tell us more about your interest!

Your Name:

Your email address:

Personal Background

Please share some information about yourself so that we can create a diverse membership that represents the many cultures of Norwalk.

Gender

Female

Male

Non binary

Prefer not to say

Clear selection

Age Range

Under 18

18-24

25-44

45-64

65+

Clear selection

We are particularly interested in involving members of minority, underserved, or immigrant groups. If you're comfortable doing so, please share any racial/ethnic, cultural or other background(s) you identify with.

Interest in Joining Prevention Coalition

Why is substance use prevention important to you?

What are some ways you might be able to contribute? (sharing parenting concerns, bringing information to other community groups, gathering data, putting up signs, translating materials, helping with social media, marketing, planning, youth engagement, etc.)

What role(s) would you fill on the coalition? (Please check all that apply)

Parent

Teen or young adult

Person in recovery

Leader from a local faith community

Business owner

Member of local youth-serving organization

Member of local civic/volunteer organization

Healthcare representative

Law enforcement representative

School representative

Substance use professional

Media

Local government official

Are you usually available for our meetings starting at noon on the last Wednesday of each month? In 2022-23, our September, January, March and May meetings will be LIVE from 12-1:30, while the other monthly meetings will be VIRTUAL from 12-1pm.

Yes, usually

Occasionally

No, prefer to be involved some other way

Clear selection

Do you plan to attend our 2022-23 kickoff meeting on September 28th from 12-1:30 at Norwalk City Hall in the Community Room? (If you're not sure, you can RSVP later to mwatt@positivedirections.org.)

Yes

Clear selection

Please indicate if you would like to join one of our committees. (Most meetings are online.)

Alcohol Committee (meets 2nd Wednesdays from 4-5pm online)

Marijuana Committee (meets 1st Thursdays from 4-5pm online)

Data Committee (meets as needed; in fall 2022 we will conduct a youth survey)

Freshman Forum Committee (meets to plan event for November)

NorWALK for Mental Health Planning Committee (meets in spring to plan event for May)

Parent Newsletter Committee (meets monthly during school year)

Please add any other information you'd like to share with us:

Please share the name and email of anyone you'd like to recommend to join this coalition. Feel free to share this sign-up form with them: tinyurl.com/norwalkcoalition

Thanks for your time & interest! We'll get back to you soon. Please like & follow our Facebook and Instagram pages @thenorwalkpartnership! And be sure to check out our website and subscribe to our blog posts at www.TheNorwalkPartnership.org. That is the best way for you to get information, resources, upcoming trainings and support groups and other information to share to your networks!

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