Community Request for Council of Elders Development Assistance
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Email *
Contact Person (Name, Address, Phone, snail mail, email)
Community Name and Description (Include city, state, county, neighborhood name [if applicable], primary issue/concerns facing the community)
Brief description of community: History, demographics *
Description of planning committee: Are there at least three (3) people interested in participating on your planning team for a Council of Elders? y/n
Names and email addresses of Planning Committee Members *
To whom/where should Council Start-up Kit be sent? *
A copy of your responses will be emailed to the address you provided.
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