Thank you for participating in the creation of a searchable online directory about individuals engaged in research, innovation, and education about aging in Ontario sponsored by the Seniors Health Knowledge Network (SHKN) and Ontario Interdisciplinary Council for Aging and Health (OICAH).

Benefits of participation:

· Expanding multidisciplinary networks

· Increased awareness of others’ work/project(s)

· Identifying possible collaborators for grant applications

· Building partnerships

· Informing aging research and practice

· Opportunities to disseminate knowledge via webinars, articles, and blogs through the SHKN

The survey should take up to 10 minutes to complete and will collect information about your demographics and interests to be included in a profile on an online directory.

By responding to this survey, you are agreeing to be listed in the upcoming directory on research, innovation and education on aging in Ontario.  You may end your participation and remove any or all information you provide at any time.

In the upcoming months, we will email you to verify your profile information prior to publication of the directory.
After the directory is published, we will send biannual emails to verify that your information is current.

If you have any questions, please contact the SHKN Assistant, Izabelle Siqueira at siqueiri@providencecare.ca or 613-544-4900 ext. 53330.
Thank you in advance for your participation.

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* 1. For our directory, please provide the following information
(Required: name and active email/ phone number)

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* 2. If you would like to include your headshot, please upload a photo

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 3. If your group or organization is interested in being featured on the directory, please provide the following information:

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* 4. What would you describe yourself as? (select all that apply)

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* 5. What are your main interests in aging? (select all that apply)

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* 6. Please share a short description of what you are mainly working on, including the issues you hope to improve. (100 word limit) 

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* 7. Are you currently part of any Community of Practice (CoP), Community of Interest (CoI), or working group? If so, which one(s)?

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* 8. How interested are you in the following aspects of the directory?

  Not at all interested  Slightly interested Somewhat interested Moderately interested Highly interested
Expanding multidisciplinary networks and partnerships
Increasing awareness of other’s work/ project(s)
Finding collaborators for grant applications
Informing research and practice
Leading webinars, articles, and blogs through the SHKN
Participating in collaborative learning opportunities with educators and learners in Ontario

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