MCSHC Membership Agreement

Are you completing this application as:(Required)

an Organization

an Individual

Organization Name(Required)

Person Completing Application(Required)

First Last

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Organization Address(Required)

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Email of Person Completing Application(Required)

Organizational Website

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We agree to support the Vision, Mission and Core Values of the Missouri Coordinated School Health Coalition (MCSHC). We pledge to contribute time, resources, and expertise to actively support the mission of MCSHC in the following ways (mark all that apply):(Required)

We identify that our organization matches the following areas (see description for the WSCC Components):(Required)

Promote and use the WSCC model as a guide for improving students’ health & their capacity to learn

Distribute, on behalf of the coalition, information about the work of MCSHC

Encourage additional individuals or organizations to join in MCSHC’s collaborative efforts

Provide support for MCSHC publications by contributing content, printing, distributing, and/or promoting

Provide resources for schools related to an area of focus

Other not listed

Name(Required)

First Last

Title(Required)

Organization/Affiliation(Required)

Address(Required)