2024 PHW Collaborative Pledge

1 Start 2 Complete

Welcome to the PHW Collaborative Pledge Form!

We are so glad you are taking the first steps to partnering with us. Please read all instructions and requirements before proceeding to the form.

What is The Collaborative Pledge?
The purpose of the Collaborative Pledge is to ensure that your faith community and PHW are on the same page about being committed to health as a faith issue. We also use the information you provide us in the pledge to get to know what your health priorities are, and to be better equipped to walk alongside your faith community in your journey to health and wholeness.

PLEASE NOTE: This Collaborative Pledge form is NOT a grant application. If you are eligible to apply for a grant, we will include an application link in your Collaborative Pledge acceptance email. Information on our current grant offerings can be found at healthandwholeness.org/mini-grants.

Tips for filling out the Collaborative Pledge:
Consider the Collaborative Pledge as your opportunity to introduce yourself to us. We want to know what's most important to your faith community with respect to our FOCUS AREAS. PHW currently has seven focus areas:

We want to know where your health ministry plans to focus its energy in one or more of these focus areas. WE DO NOT EXPECT YOU TO BE ACTIVELY PURSUING WORK IN EVERY FOCUS AREA. Don't feel like you have to impress us by doing something in every area. We are only interested in knowing what's important to you.

Please note: You must complete this form in one sitting. You cannot save your work and come back. We recommend typing your answers in a separate document before you begin filling out the form in case the form does not successfully submit for any reason.

If you have any questions, don't hesitate to contact phwinfo@ncchurches.org.

Now that we've got all that out of the way, let's get started!

Collaborative Pledge Agreement

By submitting this application you are agreeing to the PHW requirements of:

  1. Maintaining tobacco free buildings on worship grounds
  2. Serving healthy food and drink options at congregational activities, events, and meetings
  3. Asking Faith Leader to complete the Clergy Commitment (this should be done prior to completing the Collaborative Pledge form)
  4. Sharing the message of health as a faith issue
  5. Integrating at least one church-based activity based on one of the seven focus areas of the PHW program: tobacco/nicotine education, healthy eating, increased physical activity, mental health advocacy and education, overdose/substance use, HIV, or healthy aging.

Additionally, by submitting this application, I certify that I and my faith community adhere to the following requirements:

  1. The organization is a worshiping faith community that meets regularly at a physical location in North Carolina.
  2. The Health Lead (person completing this form) is either an active member of the congregation or on staff at the time of submission.

Contact Information

Congregation Contact Information
PHW Health Lead's Contact Information
Faith Leader's Title and Contact Information

Congregation Specifics

Being Healthy, Being Faithful-Tell us about your Health Ministry

Joys and Challenges of the Past 12 Months

In this section, we hope to get a better idea of what your health ministry has been up to in the 12 months prior to you filling out this application. In each of our focus areas, please tell us if your health ministry's efforts are BEGINNING, SUSTAINING, EXPANDING, or NOT A FOCUS. Remember, we do NOT expect you to have been active in every focus area. We want to know what is important to you.

Goals and Plans for the Next 12 Months

Use this section to tell us where your health ministry is headed in the next 12 months. In each of our focus areas, please tell us if your health ministry's efforts are BEGINNING, SUSTAINING, EXPANDING, or NOT A FOCUS. Remember, we do NOT expect you to be actively pursuing every focus area. We want to know what is important to you. For each applicable focus area, please provide a detailed paragraph of what you hope to accomplish in the coming year. If you do not have plans to work in a particular focus area, simply type N/A.

Partners in Health and Wholeness History

Wrap Up

What's Next?

  1. You will receive an automated confirmation email when this form is successfully submitted. A copy of your responses will be sent to you and your faith leader. This confirmation email does not indicate formal acceptance into The PHW Collaborative, simply that your application has been received.
  2. You will receive a formal acceptance from our office within three weeks. If we are offering grants that you are eligible for and we are in an open cycle, you will receive instructions on how to apply.

Please direct any questions to phwinfo@ncchurches.org. We will be glad to assist you!