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  • Program Engagement Agreement

    A Matter of Balance Program
  • Part 1 of the two-part Program Engagement process.

    The purpose of this Program Engagement Agreement is to provide clear expectations for the host organization (named here) in implementing the evidence-based A Matter of Balance (AMOB) program within the host organization's community - as part of the grant awarded to the Northern Virginia Falls Prevention Alliance. 

    This form is to be completed by the Primary Point of Contact of the Host Organization.

  • HOST ORGANIZATION


  • PROGRAM IMPLEMENTATION SITE


  • PROGRAM SCHEDULING

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  • PROGRAM COACHES

    PLEASE NOTE: Two coaches are required to lead this program
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  • Part 2 of this A Matter of Balance Engagement process consists of:

    (A) Supplies/equipment provided by the grant for the program at this site

    (B) Expected implementation process dates and timelines.

    After submitting this form, we will get in touch with you for next steps.

    Thank you for completing this A Matter of Balance Program Engagement Agreement!

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