To register to become a We Can! Community Site, please
fill out all necessary information, and
click the "submit" button at the bottom of this page. A member of the We Can! staff will review your registration information and approve you as a site. Please allow two weeks for the approval process. If you prefer
to fax your information, please download and print a
PDF Version of this form and fax a completed form to the NHLBI Health
Information Center at (301) 592-8563. Note that you do not need to sign up to be a Community Site to download resources from the We Can! Web site; however, you can sign up if you intend to conduct programming and may need technical assistance or support.
Once you have been approved as a We Can! community site, you may request technical assistance on conducting programming from the We Can! staff. If you provide information to us that you would like featured on the We Can! Web site and other venues, we will contact you to
verify or clarify any information if necessary. The NHLBI will use your personal information only in the ways indicated in our Privacy Statement at http://www.nhlbi.nih.gov/about/privacy.htm. Submissions that promote businesses or commercial activities or products will not be accepted.
* Denotes a required field
Please do not use the following character combinations when filling out the form:
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Intended Level of Commitment
Please provide contact information.
Completing this form to list your information on the We Can! Web site is voluntary. However, before we can post your
information, you must identify yourself so that we can easily verify or clarify
any information if necessary. The NHLBI will use your personal information only
in the ways stated in our privacy statement. View our privacy statement at
We Can! Community Sites Resources
To assist your planning, implementation, and overall We Can!
experience, please review and SELECT your preferences regarding information to receive and communications with your organization.
We Can! Community Site Starter Kit
The Community Site Starter Kit is a useful set of materials that includes the
- We Can! Community Toolkit: Energize Our
Community: Toolkit for Action (this toolkit contains the We Can! Parent Curriculum)
- We Can! Program Posters
- We Can! Brochure
- We Can! Parent Handbook: Families Finding the
Balance: A Parent Handbook (one copy in English and one copy Spanish).
- We Can! wristbands (two adult-size and two
- Additional materials from We Can!
Please click the "Submit" button below
and your form will be sent to the We Can! national
If you have any questions regarding this process, please contact
the NHLBI Health Information Center by e-mail at
firstname.lastname@example.org or by phone at 301-592-8573; TTY: 240-629-3255;
or toll-free at 1-866-35-WECAN.