2020 Partners in Health and Wholeness Collaborative Pledge

Attention: Changes to the PHW Submission Process

In order to make the submission process more efficient, we have updated our PHW Collaborative Pledge. You will no longer be able to save and come back to the Pledge form. We recommend you print this document to prepare your responses BEFORE entering them on this form. We also highly recommend you save your answers on a separate document as you fill out the Pledge so that you do not lose your responses if the form closes for any reason. If you would like assistance saving your answers or printing the form, please feel free to contact your regional coordinator or our Program Coordinator, Michelle Peedin, at PHWinfo@ncchurches.org. Thank you so much for your cooperation!

Please read all instructions and requirements before proceeding to the form.

If you need assistance completing the form, please don't hesitate to contact your regional coordinator or the PHW Program Coordinator, Michelle Peedin, at PHWinfo@ncchurches.org.

Once your PHW Collaborative pledge has been accepted, you will be eligible to apply for a mini-grant within the following 12 months. Our mini-grant cycles for 2020 will be: February-March, June-July, October-November. Please complete the PHW Collaborative at least 3 weeks before submitting a PHW Mini-Grant application in order for us to respond to everyone in a timely manner.

Pledge Guidelines

When filling out the Pledge form, please type every name out fully with no abbreviations including congregation names, health lead names, and faith leader names. For example: Instead of writing Any City UMC, please write Any City United Methodist Church. This will ensure your Pledge gets added properly to your account. We also ask that you please give us as much detail as possible. The more information we have, the easier it is for us to understand all the wonderful things your health ministry is doing.

Partners in Health and Wholeness Collaborative Criteria

For congregations joining the Partners in Health and Wholeness Collaborative, we require the following commitments to health and wholeness:

  1. Maintaining tobacco free buildings on worship grounds
  2. Serving healthy food and drink options at congregational activities, events, and meetings
  3. Asking your clergy person or Faith Leader to complete the Clergy Pledge
  4. Sharing the message of health as a faith issue
  5. Integrating at least one church-based activity based on one of the four cornerstones of the PHW program: tobacco cessation and prevention, healthy eating, increased physical activity, or mental health awareness

The Partners in Health and Wholeness program is supported by The Duke Endowment and the Blue Cross Blue Shield of North Carolina Foundation. This program supports worshipping communities and congregations across the state of North Carolina. Due to our grant guidelines, we are unable to support non-profit agencies.

*We define a worshiping community as a regular congregation that holds regular religious services in an established place of worship that also has a health ministry or would like to start a health ministry dedicated to the health and well-being of its members and its surrounding community.

If your health ministry does not meet the above criteria, please contact your regional coordinator or our Program Coordinator, Michelle Peedin, at PHWinfo@ncchurches.org for assistance.

For more information and a list of our FAQ's CLICK HERE.

ONCE YOU HAVE SUCCESSFULLY SUBMITTED THE FORM, PLEASE CHECK TO MAKE SURE YOU HAVE RECEIVED A CONFIRMATION EMAIL

A copy of your pledge submission will be sent to you and your faith leader. If you do not receive a confirmation email, please contact your regional coordinator as soon as possible.

Are you submitting a New PHW Collaborative or a PHW Collaborative Renewal?

If you are a first time applicant or it has been more than 24 months since the last time you joined the PHW Collaborative, please mark "New PHW Collaborative"

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

Success and Challenges - Past 12 Months

Please describe what healthy HABITS, PROJECTS, or PROGRAMS your health ministry has continued or adopted in the PAST 12 months in each "AREA OF HEALTH" below. Please use as many details and examples as possible. Think of this as your opportunity to showcase what your health ministry has begun, sustained, or expanded on in the past 12 months.

Goals and Plans - Next 12 Months

Partners in Health and Wholeness History

Wrap Up

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 Pledge
  4. Sharing the message of health as a faith issue
  5. Integrating at least one church-based activity based on one of the four cornerstones of the PHW program: tobacco cessation and prevention, healthy eating, increased physical activity, or mental health awareness

4 + 3 =