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Partnering with Family Caregivers Learning Collaborative

Thank you for your interest in the National Center for Equitable Care for Elders' Partnering with Family Caregivers Learning Collaborative. This learning collaborative will highlight family caregiving as an essential part of age-friendly healthcare. Participants will utilize techniques like care mapping to visualize available supports and tailor assistance to unique caregiver social needs.  Sessions will be held on October 13th, October 20th, October 27th, and November 3rd  from 2:00-3:00 PM ET/11:00-12:00 PM PT.
1.What is your first and last name?
2.What is your email address?
3.If you'll be calling in during each learning collaborative session, what phone number will you be using?
4.What is the name of your organization? (Note: Our training and technical assistance is intended for HRSA-funded health center and health center program look-alike personnel. If you are unsure if your organization is a HRSA-funded health center or look-alike, you can check out HRSA's Find a Health Center resource for clarification.)
5.Organization Type
6.If you indicated "other" above for organization type, please explain here:
7.What is your position? 
8.Supervisor Name 
9.Supervisor Email
(Note: Supervisors will be contacted and asked to acknowledge their support for your participation in this activity.)
10.How did you hear about this learning collaborative?
11.Why did you register for this learning collaborative?
12.What do you plan to do with the information you learn from this learning collaborative?
13.How ready are you to implement the information from this learning collaborative at your health center?
14.What percentage of your health center's patient population are older adults aged 65 and older?