Community Coalition and Group Request Form
Healthy Marathon County is committed to making Marathon County the healthiest county in Wisconsin. Our members,
who live and work in Marathon County, collaborate with community partners to build systems, environments, and a
culture that supports health and wellness. http://healthymarathoncounty.org
Healthy Marathon County is here to assist you to advance your mission that supports one or more of the 2017-2020
Marathon County Community Health Priorities. http://marathoncountyhealthpriorities.org To read more about what
type of assistance Healthy Marathon County can provide refer to Healthy Marathon County website.
To make your request, please complete the following form and submit to Chris Weisgram at [email protected].
Healthy Marathon County will review your request within 14 days and inform you if they can meet your request. You
are welcome to attend a Healthy Marathon County Board meeting to present your request. For date/time of the next
Board meeting contact Chris Weisgram at [email protected].
Health Priority - Please check the health priority(ies) this request supports:
Adverse Childhood Experiences
Behavioral Health
Healthy Weight
Alcohol & Other Drugs Misuse & Abuse
Health Needs of Aging
Oral Health
Request: What would you like Healthy Marathon County to contribute? Please provide detailed description of the
request (e.g., submit a letter to editor, attend a meeting, provide connections to key stakeholders, leverage
resources).
(insert response)
Advance Health Priority: How does this request support your mission and advance one or more health priority
strategy?
(insert response)
Timeline: When do you need the decision made by? When does action need to occur?
(insert response)
Contact Information:
Name:
Community Coalition or Group:
Contact Information (Email and Daytime Phone No.):
1000 Lake View Drive, Suite 100 | Wausau, WI 54403 | www.healthymarathoncounty.org