Community A.C.T.I.O.N. for Moms Mental Health
Agreement for Pilot Sites & Early Adopters

name of coalition/organization
I, *
I,
name of leader authorized to enter into this agreement
agree to participate in Community A.C.T.I.O.N. for Moms Mental Health, a project of 2020 Mom. Our coalition leadership understands that 2020 Mom will provide a toolkit, listserv, and webinar training series for participating organizations with a goal of supporting community mobilization for improved maternal mental health care. We enter into this agreement with 2020 Mom to participate in the pilot testing of these materials beginning today and extending through December 31, 2017. As a representative of the coalition named above, I understand and agree that our organization has or will: *
By clicking submit, you confirm that you have read the agreement, understand the terms, and give consent for your coalition to participate in the Community A.C.T.I.O.N. pilot project.