AgingIN Changemaker Awards Survey

1.Nominee's name, job title, and affiliation(Required.)

Name

Title

Affiliation

Email Address

2.Please describe how the nominee's dedication and innovative efforts have improved the lives of older adults; helped to reshape systems of care; and advanced policies that promote dignity, equity, and quality of life.(Required.)

3.Please describe how the nominee is a catalyst for progress. This could include pioneering new models of care, influencing critical legislation, conducting groundbreaking research, or dedicating their lives to caring for older adults. In addition, describe how the nominee has contributed to the transformation of eldercare today and will continue to inspire and guide future improvements in the field.(Required.)

4.If possible, please include any testimonials or endorsements from colleagues, beneficiaries, or community members that speak to the nominee's impact and alignment with the award’s purpose.

5.Your contact information(Required.)

Name

Title

Affiliation

Email Address

6.Please describe your relationship to the nominee. How do you know this person?(Required.)

Current Progress,

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