If you or your organization is interested in becoming a member of the Tampa Bay Healthcare Collaborative please complete the application below and submit by clicking the ‘Send’ button. Someone will contact you once your application is received and reviewed.





Please describe the mission/purpose of your organization and briefly describe the services provided:

Briefly discuss why you are applying for membership. What does your organization hope to gain from participation and how could it be of assistance in our efforts?

Are you aware of any activity in which you are engaged, personally or professionally, that would constitute a conflict of interest with the purpose, mission, and/or focus of the Tampa Bay Healthcare Collaborative? If yes, please explain.

May we list your organization as a Tampa Bay Healthcare Collaborative member in our literature?

 Yes No

MEMBERSHIP AGREEMENT
(previous read the 'Terms and Conditions' of membership described below)

Members of the Collaborative adopt the mission and jointly agree to:
1. Explore new methods to utilize existing resources and proactively seek additional resources to meet remaining needs in our communities. Work toward a mutually beneficial environment where collaborative successes are beneficial to member agencies and thus communities in need.
2. Investigate and pursue innovative approaches for delivering health and human services seeking maximum involvement and empowerment of community members.
3. Work together to remove barriers and find solutions for effective service delivery systems through collaborative decision-making and action.
4. Capitalize on the diverse, unique, and effective skills in the Tampa Bay region. Work to create a regional network of shared information and resources.

Specifically, members commit to support the work of the Collaborative:
1. Actively participate through planning sessions, committees, workgroups, forums, or related activities.
2. Designate a consistent agency representative to attend quarterly meetings, act as the point of contact, and keep Collaborative staff informed of changes. Designee will keep agency informed of Collaborative activities and initiatives.
3. Take advantage of opportunities to create awareness of the Collaborative. Place Collaborative web page with “related links” or “community initiatives” on agency web page.
4. Support Collaborative initiatives through in-kind donations of materials, time, meeting space, or related items as appropriate.

In support of these objectives and values, the Collaborative will, through its staff and governance structure:
1. Serve as the coordinating and facilitating agent for Collaborative planning and activities.
2. Establish and maintain formal communication methods for Collaborative activities.
Maintain and distribute minutes, reports, and business-related materials to members.
3. Conduct on going planning to establish strategic workplans, measurable goals, and regular reporting system for Collaborative business practices and progress toward goals.
4. Endow continuity by building trust, learning and teaching the value of collaboration, bringing diverse interests together, and promoting results.
5. Involve the community through creating visibility of the Collaborative, involving key stakeholders, holding public forums, and advocating for those in need.
6. Form strategic alliances with community groups to further Collaborative mission.

I understand that membership in the Collaborative does not constitute permission to use the Tampa Bay Healthcare Collaborative logo, materials or name without prior approval.

 I agree to the 'Terms and Conditions' above.

Download Membership Agreement | Download Membership Application