Sign On to Extend CHIP Before Funding Expires

Add your organization to show support for the continuation of the Children's Health Insurance Program.

Please note: This is an organizational sign-on letter. Please ensure that you have proper authorization and permission to add your organization to this letter.

Contact first name: *

Contact last name: *

Contact email: *

Please provide the name of your organization exactly as it should appear on the letter. (No acronyms)

Organization name: *

As you wish for it to appear on the letter. Please, no acronyms.

Organization city: *

Organization state: *

Please indicate whether your organization is a national organization or state-based organization. To ensure Members of Congress recognize support from their constiuents, we will list national organizations together, and state-based and local organizations together.

Organization scope: *

National State or local

Are you authorized to sign on your organization? *

Yes No

We will contact you by email with a final version of the letter once it has been sent to Congressional leadership.

Sign On to Extend CHIP Now!