WELCOME AND GENERAL INFORMATION

Thank you for your interest in Communities of Healing.  We are excited that you want to Imagine, Learn, Design, and Share with us as we work to make our West Virginia Communities better.  

If you have any questions about the program, please reach out to info@communitiesofhealing.com.

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* 1. First name

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* 2. Last name

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* 3. Street address

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* 4. City

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* 5. Please indicate the WV County of residence or business location.  If outside of WV, please email info@communitiesofhealing.com to get more information about eligibility.

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* 6. State

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* 7. Zip Code

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* 8. Email

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* 9. Contact phone number

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* 10. How did you hear about Communities of Healing?

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* 11. Are you a Communities of Healing Cohort Graduate?

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* 12. Are you currently operating a business or social enterprise?

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