LGBTQ Moveable Senior Center Interest Application

LGBTQ+ Moveable Senior Center

Partner Interest Application 2023-2024
SITE INFORMATION
Name of Site Contact*

First NameLast Name
Email of Site Contact *
example@example.com
Name of Senior Center*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
We are interested in becoming an LGBTQ+ Moveable Senior Center and as such a network partner of the CT Healthy Living Collective. Our Center commits to:*

Attend training and the live webinar as outlined in the applicationCreate an inclusion and belonging action planProminently display the LGBTQ+ Moveable Senior Center decal and use approved marketing and promotional materialsPlan and schedule a minimum of one or two LGBTQ+ Moveable Senior Center programs during June 2023-June 2024. Programs may run in collaboration with another local or neighboring Senior Center.Promote programs of the LGBTQ+ Moveable Senior Center from other sites and welcome participants from other municipalities or organizationsUtilize CT Healthy Living Collective centralized and secure on-line registration and survey toolsComplete and adhere to a coordination agreement with the CT Healthy Living CollectiveSelf-evaluate site readiness and inclusivity measuresRespond to quarterly check-in surveys from the CT Healthy Living Collective to schedule on-line training opportunities for new staffComply with all applicable state and federal laws, including the Americans with Disabilities Act.
Please identify your primary reason for participating.
Do you anticipate any challenges or difficulties in participating or delivering programs?
TRAINING

To ensure quick access to quality training, please provide the name, title/position and email for each person who will attend any of the following training. We will follow up with more details after reviewing your application.

March/April, 2023: Self-Paced Learning

o Three 1-hour self-paced on-demand training modules

Participation goal is 100% of on-site, forward-facing staff (directors, program staff, drivers, reception, etc)

May/June, 2023: Program Planning Phase

o One of two 90-minute live webinar on Thursday, May 11th from 9:00 – 10:30 am OR Monday, May 22nd from 2:30 – 4:00pm

Patricipation attendance is for Senior Center Directors and Program Coordinators or similar role
Click the + button to add additional names.
How is your site delivering programs?

In PersonVirtuallyBoth
Questions/Comments
Applications are open until March 7, 2023. We look forward to reviewing your application and will contact you shortly.
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LGBTQ+ Moveable Senior Center