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2018 WomenHeart Forms
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 New Forms Alert! 

We have consolidated and updated our report forms, in hopes of making it easier for you to report your monthly activities. Please be sure to read through each description carefully prior to submitting a report to ensure you are
completing the correct form.

Thank you for the time and effort that you put into WomenHeart activities. Please select your activities for WomenHeart from the available choices below.  You may also submit reports by speaking to a phone representative at 1-800- 676-6002.

If you need assistance, please contact the Patient Volunteer Programs & Services Team
at If you require immediate action, please contact WomenHeart at 202-728-7199.

Materials Request

Use this form to request materials for your upcoming events. You can order materials like WomenHeart’s Red Bags of Courage®, Thrive flyers, our award-winning educational infographics, HeartScarves and more! Prior to completing this form, be prepared to provide the event and shipping information to complete submission.


Order Business Cards


Outreach Forms

Use the forms below if you have participated in any of the following outreach activities:


Post-Event Highlights Form

Use this form to report on any of the following community outreach activities you participated in alone or as the lead WomenHeart Champion*:

·       Health fairs, panel discussions, speaking engagements, media engagements.

·       If a WomenHeart Champion participates alone, she is responsible for completing this form. If there are two or more WomenHeart Champions participating, only the lead WomenHeart Champion is responsible for submitting this form. All other WomenHeart Champion participants should complete the "Co-Form Events/Activities."

*The lead WomenHeart Champion is the one who was responsible for ordering materials for the event.


Co-Form Events/Activities

Use this form to report on community outreach activities you participated in with other WomenHeart Champions.

  • One WomenHeart Champion is responsible for completing a full report on the community event/activity called a Post-Event Highlight Form. All other WomenHeart Champion participants should submit this form to receive credit for hours dedicated, and to let us know they are still actively volunteering.
  • Please confirm that another WomenHeart Champion who participated in this community event/activity with you, will complete the Post-Event Highlight Form.
  • Co-Form for Community Outreach Activities


Monthly Activities Form

This form is for all WomenHeart Champions and should be submitted monthly to report on any of the following activities that took place during the month:

  •  HeartScarves, patient visitation (and/or other one-on-one support), promotional activities, and business/networking meetings.
  • This form documents the hours you dedicate each month, how many women you’ve reached through personal contact (one-on-one support), as well as demographic information of the women you’ve reached.

WomanHeart@Work Program


Patient Support Forms

Use the forms below if you have participated in any of the following patient support activities:


Support Network Coordinator Form:

This form is solely for Support Network Coordinators and Virtual Support Network Coordinators.


·        This form should be submitted monthly and should reflect all activities and time dedicated to managing your Support Network during the month of submission.

·       Virtual Support Network leaders should also use this form to report activities and time associated with HeartSisters Online groups.


Co-Form for Support Network Activities:

This form is solely for Support Network Coordinators leading groups with Co-Coordinators. This form should be completed:


  • To report to National Office that you and your Co-Coordinator did not host a Support Network meeting this month.
  • To report on your Support Network activity as a Co-Coordinator. (Please note: One Support Network Coordinator is responsible for completing a full report on the Support Network meeting called a Support Network Coordinator form. All other Co-Coordinators should submit this form to receive credit for hours dedicated, and to let us know they are still actively volunteering as a co-coordinator for their Support Network.)



  • SisterMatch is a program where, women connect one-on-one with a WomenHeart Champion who can provide needed support over the phone, in person, or via email, at a time convenient to both parties. It is the perfect opportunity to get more involved, while still maintaining flexibility and control over your schedule. You create your own schedule and can spend as little or as much time as you'd like!
  •  If you are WomenHeart Champion and would like to sign up to be a Big Sister please cick here

Volunteer Expenses

Please note that processing reimbursements may take up to 30 days from when the request and all supporting documents (including receipts, Support Network forms, and meeting agendas, when applicable) are received. We thank you for your patience.

Volunteer Expense Reimbursement - Submit requests for reimbursement for Support Network activities, business cards, or travel required for an event requested by National Office.

Expense Prepayment Form - Submit requests for prepayment of a large expense (more than $100), such as a Support Network holiday meeting, or District Retreat.


District Leader QuarterlyReport

District Leader Quarterly Report Use this form to record information from the previous quarter, including the district quarterly call. 


WomenHeart Champion Core Values Form:

The WomenHeart National Office is committed to providing quality support and service to the millions of women living with heart disease in the United States. WomenHeart staff has committed to building a culture of excellence by establishing our core values in July of 2015. WomenHeart Staff works hard to embody these core values in all of our work and we are hoping that our WomenHeart Champions will join us in our efforts to uphold this culture of excellence both within the National Office and externally. We call all of our volunteers to join us in acting out the core values that we strive to embody daily. The purpose of the Core Values Forms is to celebrate our WomenHeart Champions who have gone above and beyond in exemplifying these core values. In addition to highlighting the successes of our WomenHeart Champions, the forms will also help our National Office to target and problem-solve any concerns that our WomenHeart Champions face in the field.

Opportunity for Growth

Exceptional Performance 





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WomenHeart: The National Coalition for Women with Heart Disease is a nonprofit, 501(c)(3) patient advocacy organization with thousands of members nationwide, including women heart patients and their families, health care providers, advocates and consumers committed to helping women live longer, healthier lives. WomenHeart supports, educates and advocates on behalf of the nearly 48 million American women living with or at risk of heart disease. Our programs are made possible by donations, grants and corporate partnerships.

2016 Copyright - WomenHeart: The National Coalition for Women with Heart Disease
WomenHeart: The National Coalition for Women with Heart Disease is a founding partner of The Heart Truth Red Dress campaign. The Heart Truth and Red Dress are trademarks of HHS.