Coalition Inquiry Form

Request information from the coalition

Ask for coalition materials, policy updates, and participation details. You do not have to be ready to join to reach out — you can change the inquiry type below at any time.

Please do not include resident names, patient details, or any medical information.

Full name *

Email address

Provide an email address or a phone number.

Phone number

Provide an email address or a phone number.

RCFE organization or facility name *

The licensed organization you represent.

Job title or role

Optional.

Reason for contacting the coalition *

Ready to joinNeed more informationRequest a meeting

Total licensed beds across your organization

Bed counts are the total licensed beds across your entire organization, not per facility. For example, ten six-bed facilities are 60 total beds, not 0–10.

Six-month participation tier

Tiers follow your organization's total licensed bed count.

Number of facilities or locations

Optional.

Counties served

Optional.

Do not submit resident or patient names, dates of birth, medical or insurance information, Social Security numbers, financial information, or other confidential records. This form is only for provider/business contact and coalition-interest information.

Message or questions

Optional.

I confirm that I am authorized to provide this business contact information and consent to the Golden State Assisted Living Coalition and Golden Bear Strategies using it to respond to my inquiry and contact me about coalition participation. I have read the Privacy Notice. *

I confirm that this submission contains no resident, patient, medical, or protected health information. *

Read the Privacy Notice. Questions? Email Brandon Knapp at brandon@goldenbearstrategies.com.