CBHC Partnership Application

Are you interested in becoming a partner?

A CBHC Partner is a person or organization that completes a CBHC Partnership Application, which includes providing a profile, and completing a skills inventory. A Partner collaborates with CBHC on CBHC Events. If you are interested in becoming a Partner of CBHC, please complete the online application below.

    Organization / Business Name (required)

    Apply As (required)

    IndividualBusiness / Organization

    Representative First Name (required)

    Representative Last Name (required)

    Representative Title (required)

    Organization Address (required)

    City (required)

    State (required)

    Zip Code (required)

    Email (required)

    Business Phone Number (required)

    Cell Phone Number (required)


    Organization / Agency / Business (if applicable)

    Number of Members in Your Organization

    What would you like to achieve as a partner of the CBHC?

    With respect to CBHC’s mission, what strengths do you bring to the collaborative?

    How can CBHC help you/your organization reach your strategic goals?

    What are your organizations current affiliations?

    What services and activities are your organizations currently participating in?

    Organization Focus (Hold Ctrl to select all that apply)