Please complete all questions to the best of your knowledge. Please complete the survey by Friday, January 24th. The results will be compiled and discussed during a future Chapter Presidents' Forum call.

Please contact Courtney Devine at NGNA Headquarters with any questions (phone: 800-723-0560, email: Thank you for your participation in this survey!

Charlotte Radu, Committee Chair
Linda Hassler, Board of Directors Liaison

* 1. Chapter Name

* 2. Chapter President Name

* 3. Chapter President Email Address

* 4. Chapter President Phone Number

* 5. Chapter Contact for Potential Members (Please include name and contact information)

* 6. How many members does your chapter have?

* 7. How many of your chapter's members are members of the NGNA national association?

* 8. How many different healthcare facilities are represented throughout your chapter?

* 9. What types of healthcare facilities are represented throughout your chapter?

* 10. Approximately how many meetings does your chapter hold per year?

* 11. How many other activities does your chapter hold each year for its members? Please describe these activities.

* 12. Are there additional gerontological resources in your area that may be available for partnership with your chapter? If so, please name them here. Examples include GEC, LTC groups, or state gerontological associations.

* 13. How many actively participating members are currently in your chapter?

* 14. What has enabled these individuals to stay involved with your chapter?

* 15. Please describe one activity you have held that has worked well for your chapter.

* 16. Please describe one chapter activity you have held that has not been successful.

* 17. Are there any additional questions that you may have for the Chapter Presidents' Forum? Please list them here.