Innovations Committee Task Force Online Application

Innovations Committee Task Force

LeadingAge PA Innovations Committee

Thank you for your interest in serving on the first LeadingAge PA Innovations Committee Task Force! Please complete the following application by October 9.

Name of Applicant

Organization

Organization Description

Multi-site Provider

Single-site Provider

Business Partner

Other...

Provider Type if applicable (check all that apply)

CCRC

SNF

AL/PC

HCBS

LIFE

Other...

Position within Organization

Email Address

Phone number

How long have you worked at your organization?

How long have you worked in the aging services field?

Please list and provide dates if you graduated from the LeadingAge PA Fellows in Leadership program or LeadingAge National Leadership Academy

Please list any LeadingAge PA committees or task forces you have participated in over the past 5 years

Please share a Statement of Intent: why would you like to be considered for the Innovations Committee task force?

Upload your resume and/or bio below

New code

Please type the code above