Welcome to Community Health Data Base

history & background

funding sources

data sources

To become an affiliate of PHMC's Community Health Data Base simply fill out this form and click the "submit" button. A small two-year fee is required based on the size of your organization. If you have questions, concerns, or want additional information please contact us.

Contact Information:

Organization

Address

City

State

Zip

Phone

Fax Number

E-mail

Website

Primary Contact

Name

Title

Secondary Contact

Name

Title

Organization Annual Budget
(Eligibility for affiliation is based on the size of the organization)

	Less than $100,000	Fee: $25
	$100,001 - $250,000	Fee: $50
	$250,001 - $500,000	Fee: $50
	$500,001 - $1,000,000	Fee: $75
	$1,000,001 - $3,000,000	Fee: $100
For budgets greater than $3,000,000, please contact the CHDB.

Major Program Areas
(click all that apply)

	Children, Youth, & Families			Health
	Older Adults			Recreation
	Women			Substance Abuse/Mental Health
	Housing & Hunger			Advocacy/Policy
	HIV/AIDS			Other

Geographic Area Served by Your Agency

	Bucks County
	Montgomery County
	Chester County
	Philadelphia County
	Delaware County
	Other

Please tell us how you heard about the PHMC's Community Health Data Base?