Innovations Committee Task Force Online Application

Innovations Committee Task Force

LeadingAge PA Innovations Committee

Thank you for your interest in serving on the LeadingAge PA Innovations Committee's Network Workgroup! Please complete the following application by November 13.

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

Which Innovations Committee priorities are you most interested in? (Check all that apply)

Network: Strengthening peer learning, facilitating co-creation, and bridging sectors

Repository: Curating innovation resources

Advocacy: Promoting policy change

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

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