EmPOWERED to Serve Community Innovation ExchangeTM
Tell us about yourself.
Please provide a link to your organization’s website.
Tell us about the organization you are submitting to the Community InnovationExchange
What is the BIG problem that your organization addresses?
Which cities does the organization focus on supporting?
How did you hear about the CIE?
I agree to receive the ETS newsletter ( optional)
I certify that I am authorized to release this information to the American Heart Association and agree that any information provided to the AHA, whether as part of this intake form or otherwise, may be disclosed by the AHA and that I have sufficient rights, whether by implication, estoppel, or otherwise, to grant AHA the rights discussed in this form
An EmPOWERED to Serve team member will contact you after your submission to learn more about your organization.
Should be Empty: