Champions for Change Interest Form

Champions for Change: Roles & Responsibilities

Champions for Change support the Wellness Coalition REACH program by helping advance policy, systems, and environmental (PSE) changes that improve community health. Champions serve as trusted messengers, advocates, and connectors within their communities

Core Focus Areas

Healthy Nutrition Promotion & Access
- Support efforts that improve access to affordable, nutritious foods in community settings
- Promote healthy eating messages and nutrition education initiatives
- Help elevate community voices around food access, food environments, and equity
Physical Activity Promotion & Community Design
- Speak up for safer, more walkable, and activity-friendly outdoor spaces
- Inform leaders and decision-makers about barriers to physical activity in the community
- Support initiatives that encourage active living through community design and engagement
Breastfeeding Promotion & Support
- Advocate for breastfeeding-friendly policies, systems, and environments
- Support awareness of lactation access, Baby Cafés, and breastfeeding resources
- Help normalize breastfeeding and support families through community engagement

General Champion Expectations

Inspire others to make healthy, sustainable changes
Assist with planning and promoting REACH-related events (e.g., health fairs, Baby Cafés, community wellness activities)
Attend at least two (2) REACH-supported events per year
Share program updates and event information within their community networks
Participate in quarterly Champion meetings to receive updates and provide feedback
Help recruit and encourage additional community messengers to join the work

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What county do you live in?

What type of work do you do?

Which strategies do you align with most:

Click what areas and committee you are interested in being involved:

Rows	Yes	No	Maybe	Any thoughts?
Healthy Voices Committee
Trailblazer Task Force
Milk Haven Committee
Milk Haven Committee Leadership
Tour of Wellness Vendor
Partnership/Contractor

Live Experience Advisory Group (LEAG) is a new program. If you are interested in being instrumental in helping to improve Breastfeeding Continuity of Care, please click below:

Would you like to lead a county Milk Haven Committe?

Other

Please share with us who that potential team or leader is, so that we can contact them.

Why are you interested in volunteering as a Champion of Change?

As a Champion, how do you plan to assist our various programs?

How frequently do you use social media?

Which social media platforms do you use? Check all that apply.

Please upload your headshot here. Your photo will be shared on The Wellness Coalition's website.

Browse Files

I name accept to be part of the Champions for Change and commit to participating and complying with the above statement.

Signature

signed today on   Date

Champions for Change Registration Form