PCRM Logo

Building Healthy Communities - Leader Application

Thank you for your interest in starting a Building Healthy Communities group! After submitting your application, you’ll receive an email with an invitation to schedule a meeting with a Healthy Communities team member, who will be happy to discuss your ideas and answer any questions you have about launching your new community.
Leader Information










Mailing Address









Co-leader Information
You may submit this information later if you don't have a co-leader yet to help you with the group.





Building Healthy Community Location
This is the general location of your group’s events. Please choose a location where you plan to hold the majority of your events. This address is important because without it, your group will not appear on the Building Healthy Communities map. You can update this at any time. 






Building Healthy Community Group Name and Links
Please note that this is essential for setup, but you can change it later if needed.  You may select any name you like or use our standard format: “Building Healthy Communities (Insert City Name)”

Information to connect with your group will appear on your page on the website. You must provide an email address, while the other links are optional and can be added later. Your group will be displayed on the website once you are accepted into the program and ready to start accepting members.