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Latinx Task Force- Interest Form
This form is to only register your and/or your organization's interest to join the Task Force's efforts in our aim to fill the gaps collectively in latinx communities around the country.
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CONTACT INFORMATION
Your name
*
Your answer
Your email
*
Your answer
Your organization
*
Your answer
Your role
*
Your answer
City, State
*
Your answer
OPTIONAL INFORMATION
Is your organization:
Local
State
National
International
Other:
Clear selection
Is you organization/agency latinx-serving?
Yes
No
Not specifically, but we do work with the latinx community.
Clear selection
Which of the following options fits best for you:
I am personally interested to join the Task Force as an individual member.
I am interested for my organization/institution to become a partner with the efforts of the Task Force; and I would be the point of contact.
I am interested to join as a member but only will be able to provide the perspective of my organization/institution due to organizational rules.
Other:
Clear selection
How would you be interested to work with the Task Force?
To provide expertise and support in a committee(s)
To provide connections with organizations and potential partners
To join the Task Force collaborative calls
To stay in the loop and see how I can help
Other:
Are you interested to join the HACER Strategy Team?
Yes I am!
Not sure
Not right now
What expertise will you be bringing to the table?
Partnership connections and development
Communications and Resources
Web design and graphics
Funding and Grants expertise
Policy and Advocacy expertise
Data analysis and collection experience
Health and Medical expertise
Public health expertise
Community health/Promotore expertise
Government perspective (local, state, or national)
Other:
Any additional information you'd like to share about your organization and/or any exciting projects you're working on:
Your answer
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