Community Health Trust Action Team Membership Applications are welcome from members of the community. Anyone interested in assisting the Community Health Trust to meet their goals and objectives for building healthy lifestyles in the communities, both Morris and Sussex counties, should complete an application.  If you are interested in joining the Community Health Trust please print this page, complete the application and mail it to us at Saint Clare's Community Health Trust, 400 West Blackwell Street, Dover, NJ 07801-3311.

Community Health Trust Candidate Application
Date of Application:	(e.g., mm/dd/yy)
Name:
Address:
State:	Zip:
Phone:	Fax:
E-Mail Address:
	How did you learn about the Community Health Trust?
	Who were you referred by?
	Have you participated in any Community Health Trust activities? Yes No
	What other organizations, community boards, etc., are you a member of or are  involved in ?
	How do you think you can contribute to the Community Health Trust?
	Which  Action Team are you interested in serving on? (e.g., Cancer Detection, Tobacco-Free, Heart Disease, Stroke, Substance Abuse, Teen Parenting, or Community)
	What organization are you associated with?
	Does your employer support your participation on the Community Health Trust ? Yes No If yes, why?

Please note that appointment to a team may require attendance of up to two meetings per month on occasion.

 

 If you are interested in joining the Community Health Trust please print this page, complete the application and mail it to us at Saint Clare's Community Health Trust, 400 West Blackwell Street, Dover, NJ 07801-3311.