Courage 2 Love in Action Interest Form

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We are so excited that you're interested in joining a Healing Centered Learning Community for the Courage to Love in Action Movement working to improve health outcomes for black mothers, birthing people, and babies. Our Learning Communities explore how we can improve the health and well-being of women, pregnant people, and babies by building healing-centered, restorative justice skills and practices in organizations that serve families. Participants learn about how historical, interpersonal and structural trauma impact maternal and infant mortality and how positive, loving connection bring healing and protection. This is active, participatory learning that emphasizes community and the quality of our relationships with each other as essential for making meaningful organizational change. Please complete the form below and we'll get back to you as soon as possible.

Funded by The Chicago Department of Public Health's Office of Violence Prevention.

Email *

Name *

Organization *

Organization Zip Code (Must be based in Chicago to qualify) *

Name (First and Last) *

Please provide your full name as the interested participant representing an organization.

Organization/Church Name *

Please provide the full name of the community organization that you are representing.

Which category of services does your organization provide? *

Please select all that apply:

Behavioral Health/Health Care

Community Based/Faith-Based

Youth Serving

Violence Prevention

Other:

Required

Zip Code of your Organization *

Please provide the zip code of the organization that you are representing.

Phone Number *

Please provide your best contact number for program updates and enrollment purposes (preferably a mobile phone number).

Healing-Centered Learning Communities Orientation Date *

Wednesday, February 7th| 10am-11:30am

Wednesday, February 28th| 1pm-2:30pm

N/A

Required

Please confirm your language preference. *

Note: All Healing Centered Learning Communities are facilitated in English only at this time. Translation services and accommodations may be possible for future cohorts.

English

Other:

Send me a copy of my responses.

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