Memorandum of Agreement
Please select one:
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I am signing on behalf of myself, as an individual not affiliated with any organization/group.
I am signing on behalf of my organization, as a leader of my organization with decision-making power to delegate staff to Norwalk ACTS areas of work.
I hereby acknowledge that I have read, understand and agree to the terms of this Memorandum of Agreement regarding membership to Norwalk ACTS.
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Have you previously signed the Norwalk ACTS MOA?
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Yes
No, this is my first time signing the MOA
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
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This section is designated for individuals not affiliated with any organization/group to complete.
We are collecting racial/ethnic identity information about our individual membership to ensure our initiatives and working groups are representative of the Norwalk community at-large. The information collected will support our north star goal of co-creating solutions with our community and achieving racial equity in Norwalk. We acknowledge that the listed categories do not represent all identities of the community and have provided "other" categories for any information not included. This question is not required to become a member of Norwalk ACTS. Please select the racial category or categories with which you most closely identify with:
American Indian or Alaska Native
Asian or Pacific Islander
Black or African American
Hispanic or Latin(x)
White or Caucasian
Other
Employer
Listing your employer and/or affiliated organizations groups and groups does not mean you're working on behalf of these groups. Signing this MOA individual means you are acting on your behalf.
Role/Title
Are you actively engaged with any of the following types of organizations/associations? Please select the category and then enter the name of the organization/association that you are actively engaged with. You can add multiple categories with the +Add Category button below. Please add one name per category:
Engagement (Long Entry Text for Airtable)
Select the Norwalk ACTS areas of work that you are most interested in (check all that apply):
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Early Childhood Development Initiative (including Community Advocate Program)
Social Emotional Health Initiative (including former Out of School Time members & Youth Advocate Program)
College & Workforce Readiness Initiative
Data Cornerstone
Policy & Advocacy Cornerstone (including Civic Influencer Program)
Social Justice & Equity Cornerstone
Community Engagement Cornerstone
General Interest (including Quarterly Convenings and others events)
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This section is designated for a leader of the organization to complete.
Organization Name
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Role/Title
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Please designate yourself and/or your staff members to the Norwalk ACTS work areas that align with your organization and commitments. You can add multiple staff members with the +Add Staff Member button below. Any designated staff member will receive a copy of this signed MOA via email. Please brief your staff about this MOA process:
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Staff Designation (Long Entry Text for Airtable)
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