Intergenerational Community of Practice Application

Application Deadline: July 13, 2022

Please provide your contact information:

Question Title

* 1. Applicant name (first and last)

Question Title

* 2. Applicant's organization

Question Title

* 3. Title or role at applicant’s organization

Question Title

* 4. Email address

Question Title

* 5. Phone number

Question Title

* 6. Mailing address

Address

City/Town

State

Zip/ Postal Code

Question Title

* 7. Describe whether you have extensive, beginner, or no experience with intergenerational programming to address social connectedness. There are many ways Community of Practice members can contribute to the group’s strengths. What talent, experience, and knowledge would you bring to the Community of Practice (suggested 100-word count)?

Question Title

* 8. Describe the intergenerational program you are involved with or exploring and its potential for impact on social isolation and loneliness. (suggested 250-word count)

Question Title

* 9. Is this program currently in operation?

Yes. How long has it been in operation? Please describe in the comment box below.

No. What planning or exploration stage you are in? Please describe in the comment box below.

Describe here (required question).

Question Title

* 10. Describe your role with this program? (suggested 100-word count)

Question Title

* 11. What are your goals for participating in a Community of Practice exploring shared programming to address social isolation and loneliness? (suggested 250-word count)

Tell us about the community you serve:

Question Title

* 12. Does your program serve primarily urban, suburban, or rural residents? Select one that best fits.

Predominantly urban

Predominantly suburban

A mix of urban and suburban

Predominantly rural

Predominantly remote or frontier

A mix of suburban and rural

A mix of urban, suburban and rural

Question Title

* 13. Describe the composition of the population you serve (e.g., representation by gender, race, ethnicity, abilities, sexual orientation, veteran status, etc.). (suggested 250-word count)

Question Title

* 14. Does your organization serve primarily youth (24 and under) or primarily older adults (age 55+)?

Primarily youth

Primarily older adults

Both youth and older adults

Other, please describe in the comment box below

Describe here.

Question Title

* 15. Approximately what percentage of your consumers are at risk of not having basic needs met?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

Question Title

* 16. Approximately how many consumers did your organization serve in 2021?

Question Title

* 17. Approximately what percentage of the consumers you serve have a disability?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

Question Title

* 18. Briefly describe the strengths and needs of the community you serve as it relates to your interest in this Intergenerational Community of Practice. (suggested 100-word count)

Question Title

* 19. If you offer specialized programming (e.g., tailored for persons living with dementia) or programming for specific populations (e.g., a Veterans support group), briefly list/describe. If not applicable, please respond N/A. (suggested 100-word count)

Community of Practice Expectations and Acknowledgments:

Question Title

* 20. As an applicant, I acknowledge that members of the Community of Practice are expected to:

Attend all four monthly meetings scheduled from 2-3:30 PM EST via zoom/teams on the 3rd Tuesday of the month from August to November: 8/16, 9/20, 10/18, 11/15.

Participants shall be or register as Network of Champion members and review the terms and conditions by application deadline (July 13, 2022).

Complete tasks (no more than 2 hours/month) between meetings to help advance the purpose of the Community of Practice.

Share their experiences surrounding the Community of Practice and subsequent efforts in a presentation (e.g., to their organization or to collaborate with project staff on webinars or conference presentations).

Question Title

* 21. Please indicate that the applicant for this program is able to meet these criteria by attaching a letter of support from their supervisor. Click here for a template letter of support that may be used.

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

Choose File

Please understand once you submit this application, changes cannot be made. If you have any questions, contact us at info@committoconnect.org