Directory of Ontario Educators, Innovators, and Researchers focused on Aging and Related Topics in Ontario: Intake Survey

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.

Question Title

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

Full Name *

Job title(s)

Qualification(s)

Affiliated institution, organization, or group

Language(s) of work

Active email address and/or phone number *

Links (faculty bio/ linkedin)

Question Title

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

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

Question Title

* 3. If your group or organization is interested in being featured on the directory, please provide the following information:

Name of Organization :

Lead Contact for Organization:

Contact Information:

Area(s) of focus:

Links:

Question Title

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

Educator- individual whose primary role includes development and delivery of education (eg., teaching at college or university, clinical educators, and continuing education)

Researcher- individual with formal designation and funding for active research (including as collaborator)

Innovator in aging–individual introducing new methods and approaches to develop and deliver services, programs or resources to older adults

Early Researcher- individual who recently began active research as a formal position (eg., new post-doc, research assistant, PhD, Master’s, thesis project)

Other (please specify)

Question Title

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

Age-friendly communities

Caregiver support and education

Chronic disease and aging

Driving

Elder abuse

End of life/ Palliative care

Fall and injury prevention

Frailty

Health promotion

Housing (Staying at "home", retirement homes, assisted living, long term care)

Isolation

LGBTQ+ issues

Mental health

Mobility issues

Neurodegenerative diseases

Non-pharmacological treatment

Normal aging

Nutrition

Pain

Policy

Polypharmacy

Retirement and employment

Sexuality and intimacy

Sleep

Socialization and participation

Substance use/ geriatric addictions

Vaccination

Other(s) (please specify)

Question Title

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

Question Title

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

Yes (Please specify)

Question Title

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

Directory of Ontario Educators, Innovators, and Researchers focused on Aging and Related Topics in Ontario: Intake Survey

Question Title

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

Question Title

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

Question Title

* 3. If your group or organization is interested in being featured on the directory, please provide the following information:

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

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