Intergenerational Service Learning Educational Cohort Application

Thank you for your interest in joining the ISLEC. Applications must be completed in one sitting - consider preparing your responses in a separate document in advance so you do not lose your partially completed form if you have to step away. To tailor the learning to your specific interests, you will have the opportunity to select which learning sessions you'd like to attend throughout the series. If you have questions, reach out to maggie@lorishands.org

Name

Agency/Institution you represent

Position

In what city and state does your agency/institution operate?

E-mail address

Phone number

Tell us why you are interested in participating in ISLEC.

{name}

What is your agency/institution already doing related to intergenerational service learning, older adult services, and/or education for future health care professionals?

This helps us gauge everyone's current work, experience, and strengths. Current involvement in the above is not required.

{name}

How do you envision intergenerational service learning fitting into your community?

We believe that learning and implementing new ideas happens best in teams. Please provide the name of 1 - 2 additional individuals from your agency/institution or community who would like to join you for the cohort.

Applications with 2 - 3 attendees will be strongly favored over those with just one representative.

{name}

Please provide the email address for the individual(s) named above.

{name}

What sessions would you like to attend?

We will be offering several sessions over the coming months, each with a different topical focus. You are welcome to attend all or just a few depending on your specific interests. The session (November) will provide a high level overview of intergenerational service learning and an introduction to the topics we'll cover in more detail later on throughout the learning series. All sessions will take place from 2:30 - 4pm.

When more people are versed in best practices related to intergenerational service learning, initiatives are more likely to be successful. To that end, please list 1 - 2 agencies or institutions you would be interested in partnering with and so would hope to have attend the learning cohort with you.

{name}

If there's anything else you'd like to share with us, please do so here.

{name}

Do not submit passwords through Airtable forms. Report malicious form

Alert