Common Health Coalition join form

Joining the Coalition is easy. If you are a health care or public health organization, just fill out the form below and tell us what you plan to do (or are doing!) to advance the mission. We welcome all types of organizations — from hospitals, health insurers, and health departments to schools of medicine, nursing, and public health, among others!

Importantly, joining the Coalition does not indicate an endorsement of all activities promoted by the Coalition nor its members.

You can expect to hear from us in about three weeks. If you have any questions, please read our FAQ or email info@commonhealthcoalition.org.

First name*

Last name*

Email address*

example@example.com

Organization name*

Type of organization*

State*

Name of tribe

City*

Which of the six commitments is your organization most interested in?*

Please tell us about your organization and why you would like to join the Coalition.

Which of the six commitments is your organization most interested in?*

Establish and codify collaboration.More easily get staff where and when they are needed.Share data in real time to advance equitable outcomes.Expand electronic disease reporting.Standardize readiness across the health care system.Advance existing federal efforts at the intersection of health care and public health.

What specific actions, either from our commitments page or ones that your organization is planning or already taking, will you implement to advance the Commitment(s) you’ve identified above?*

I acknowledge that the organization I work for has approved this application to join the Coalition.

I acknowledge that the organization I work for approves being named as a member on commonhealthcoalition.org.

* Indicates a required field

We do not share your personal information with outside parties. View our privacy policy.

Complete the form below to apply to join the Coalition.