2020 Partners in Health and Wholeness Collaborative Pledge

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

If you need assistance completing the form, please don't hesitate to contact our PHW Program Coordinator, Michelle S. Peedin, at PHWinfo@ncchurches.org or contact a PHW team member.

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 in a timely manner.

Attention

  • You are not 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.
  • A copy of your pledge submission will be sent to you and your faith leader.
  • ONCE YOU HAVE SUCCESSFULLY SUBMITTED THE FORM, PLEASE CHECK TO MAKE SURE YOU HAVE RECEIVED A CONFIRMATION EMAIL

If you do not receive a confirmation email or if you would like assistance saving your answers or printing the form please contact our Program Coordinator, Michelle S. Peedin, at PHWinfo@ncchurches.org or the appropriate PHW team member based on focus area or location. Thank you so much for your cooperation!

Pledge Guidelines

When filling out the form, please type every name out fully with no abbreviations including congregation names, health lead names, and faith leader names.

Example: St. Maria's United Methodist Church
NOT: St Marias UMC

This will ensure your Pledge gets added properly to your account. As we continue to expand our network, we hope you will continue to include as much detail as possible in the PHW forms. We ask Health Leads to always answer the 5 W's: Who, What, When, Where, and Why?

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 feader to complete the Clergy Commitment.
  4. Sharing the message of health as a faith issue.
  5. Integrating at least one church-based activity based on one of the five focus areas of the PHW program: tobacco cessation and prevention, healthy eating, increased physical activity, mental health advocacy and education, or healthy aging.

The Partners in Health and Wholeness program is supported by The Duke Endowment. 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 worshipping community as a congregation that holds regular religious services in an established place of worship and also has a health ministry or would like to start a health ministry dedicated to the well-being of its members and its surrounding community.

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

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

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 Commitment
  4. Sharing the message of health as a faith issue
  5. Integrating at least one church-based activity based on one of the five focus areas of the PHW program: tobacco cessation and prevention, healthy eating, increased physical activity, mental health advocacy and education, or healthy aging.

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