Senior Resource Connect Best Practice Collection Survey

Thank you for taking the time to share your program with our network! The program will be reviewed by a committee of senior services professionals and included in the Senior Resource Connect Best Practice Resource Guide, which will make descriptions of successful and replicable programs available to AJFCA member agencies. Please fill out the collection survey below in full. AJFCA will be in touch with your contact person with any clarification questions and will contact them annually to request information about program updates.

Question Title

* 1. Agency Information

Agency Name

City, State

Contact Person Name and Title

Contact Email and Phone Number

Question Title

* 2. Program

Program Name

Program Website/URL

Question Title

* 3. Program Category (check all that apply)

Transportation

Care Management

Caregiver Support

Home Care

Information and Referral

Mental Health

Socialization

Meals/ Food Security

Holocaust Survivor Support

Alzheimer's and Related Dementia

Career Services

Affordable Housing Initiatives

Other (please specify)

Question Title

* 4. Program Description (400 words max)

Question Title

* 5. Please explain how the program is evaluated, including any metrics measured, software/ database tools used, and frequency of measurement.

Question Title

* 6. Please list 2-3 program outcomes.

Question Title

* 7. Financial information

Agency Budget

Program Budget

Primary Funding Sources

Secondary Funding Sources

Expected Funding Source for Next 3 Years

Question Title

* 8. Program Execution

Years in operation

Number of FTE staff

Number of clients served annually

Size of potential client population in catchment area

Approximate percentage of clients that identify as Jewish

Does the program have an impact on other programs offered by your agency?

Do you have plans to expand your services or client base?

Question Title

* 9. Please briefly explain the inception of this program and note how stakeholders were involved in program planning and implementation.

Question Title

* 10. If this program is a collaboration, please list the agenies with which you partner and provide a brief description of what makes the collaboration successful.

Question Title

* 11. Explain how this program relates to existing theories and evidence. Please reference any specific articles used in the development of the program.