2025 Check It! Challenge Participation Form

2025 Check It! Challenge Participation Form

As part of the regional Check It! campaign, the American Heart Association is issuing a challenge to YOU! The Check It! Challenge is a four month long program to encourage individuals to know their numbers and make healthy lifestyle changes known to lower blood pressure. From February (American Heart Month) through May (American Stroke Month & National High Blood Pressure Education Month) we want individuals and organizations to commit to Check blood pressure at least twice a month; Change to healthier habits; and Control blood pressure!
The Check It! Challenge will run from February 1st through May 31st. Please fill out this participation form to have a representative from the American Heart Association assist you in your efforts; allow 1-2 business days for a personalized response. For assistance, email: checkitNY@heart.org.
Are you participating as a Check It! Challenge Organization Champion or as an individual community member?*

Check It! Challenge ChampionIndividual Community MemberNone
Organization Type:*

WorkplaceHealthcare Provider/Health System/ClinicFaith-based OrganizationSchool/School DistrictCollege/UniversityHousing FacilityHealth DepartmentOther
Organization Name*
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization Size*
Who will be your Check It! Champion (site leader)?*
First and Last Name*

First NameLast Name
Email*
example@example.com
Check It! Champion email address:*
Please enter valid email address; Check It! Challenge communication are sent via email.
Check It! Champion Phone Number*
Please include extension information for direct contact.
How will you encourage participants to monitor their blood pressure? (select all that apply)*

Onsite blood pressure cuff/kioskOnsite biometric screeningsPromote local screening opportunitiesNot sure yetOther
Is there anything we can do to assist you in setting up your blood pressure program?*
Would you like to be registered for the four Check It! Challenge monthly webinars?*

YesNo
My organization would like to learn more about: (select all that apply)*

National Wear Red DayHeart WalkWell-Being Works Better ScorecardTarget: BP (for healthcare organizations only)Other
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