Form Healthy People 203 Healthy People 203 Healthy People 2030 Champion Application

Healthy People 2030 Champion Draft Application

Become a Healthy People 2030 Champion

The Office of Disease Prevention and Health Promotion (ODPHP) invites organizations that support the tenets of Healthy People 2030, and its goal to eliminate health disparities and achieve health equity by addressing disease prevention and health promotion, social determinants of health (SDOH), to become Healthy People 2030 Champions. Champions play a critical role in supporting the Healthy People 2030 vision and achieving its objectives in communities. Please complete this form to provide information about your organization and how it supports the Healthy People 2030 vision: A society in which all people can achieve their full potential for health and well-being across the lifespan.

Healthy People 2030 Champions Process:

1. Complete the application below and return it to [email protected]. Please answer all of the questions in the application.

2. Your application will be reviewed by ODPHP and will be evaluated according to your organization’s commitment to support the overarching goals and objectives of Healthy People 2030.

3. Applicants will be notified of their application status roughly within 6-8 weeks of the application submission date.

4. Approved organizations will be recognized as Healthy People Champions and be listed on the health.gov/HealthyPeople website acknowledging their alignment with Healthy People 2030’s vision.

5. Healthy People Champions will receive a promotional package, which includes a digital graphic that can be displayed on their organization's website and social media tools.

Healthy People 2030 Champion Applicant Information:

1. Point of Contact Information:

a. Name:

b. Email:

c. Alternate Point of Contact Name

d. Alternate Email:

2. Organization Information:

a. Name:

b. Address:

c. Website URL:

d. Year of Organization’s Establishment:

e. Type of organization:

• For Profit Business

• Non-Governmental Organization

• Non-Profit Organization (501c3)

• Professional Membership Organization

• State, Local, County, Territorial, or Tribal Health Department

• Other: _____________________________________

f. Please indicate whether your organization works at (select all that apply):

• National level

• State level

• County level

• Territorial level

• Tribal level

• Other: _____________________________________

g. Provide a brief description of your organization below, identifying the organization’s, mission, vision, and purpose (250 words or less).

h. Please describe your organization’s key audiences:

i. Please list your organization’s communication vehicles (e.g., newsletters, listservs, social media handles). Please also provide estimates of the reach (e.g., # of followers or subscribers) of each:

j. Please describe your organization’s stakeholders and their role in helping achieve the organization’s mission:

k. Please provide a description and an estimate of the number of people served by (or members of) your organization:

l. Please indicate whether your organization is involved in cross-sector activities with the following sectors (Select all that apply). Write in other sectors you with which work closely:

• Civic

• Economic

• Education

• Health

• Housing

• Transportation

• Other: ___________________________________________

3. Organization’s support of Healthy People 2030

a. Please provide a brief statement on how your organization works to address disease prevention and health promotion, the social determinants of health, health disparities; and achieve health equity, or well-being as outlined in Healthy People 2030 Framework (250 words or less):

b. Healthy People 2030 Champions are asked to commit to supporting the overarching goals and objectives of Healthy People 2030. Please identify at least 2 Healthy People 2030 topics or objectives your organization is committed to addressing during the course of the decade:

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Thank you for your interest in becoming a Healthy People 2030 Champion. If you have questions, please email [email protected].

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