Community Request for Council of Elders Development Assistance
Sign in to Google to save your progress. Learn more
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.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy