Older Adults Programs Registration Form

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The African Center for Community Development is introducing two Older Adults Programs for all older adults ages 55 and above living in Madison and Dane County.

The Programs include:

The Community Elder Connect - provides information and referrals to a range of services to older adults. Some of these services include disability services, accessible transportation, healthcare, mental health, exercises, housing support, affordable food, ethnic grocery shopping, language assistance etc.

The Baobab Senior Circle - Provides a safe space for sharing cultural knowledge and experiences, and for engaging in intergenerational dialogue, networking, peer emotional support and field trips.

Where:

UW South Madison Partnership, 2238 South Park Street, Madison, WI 53713

When:

Every second & last Friday of the month - 3:00 to 5:00 PM

Please register below.

For more information or any questions, please call Inyillah at (608) 509-6804 or email her at inyillah@africancentermadison.org

Your Full Name

Your Home Address

Your Phone Number (Please give us the best number to reach you)

Your Email Address

What is your age range?

55 to 60

60 to 65

65 to 70

70 to 75

75 to 80

80 and above

Clear selection

Which category describes you? Please select all that apply

American Indian or Alaska Native

Asian

African

Black or African American

Hispanic, Latino or Spanish Origin

White

Prefer not to disclose

Other:

Clear selection

If you selected African, which region of Africa is your home country located in?

West

East

South

North

Clear selection

What is the name of your home country in Africa?

Which of the following are you more interested in?

Resource referrals

Networking

Cultural exchange

Field trips

Intergenerational dialogue

Peer emotional support

All of the above

Do you have any dietary restrictions you want us to know about?

Will you be needing transportation?

Yes

Clear selection

If you need transportation, please provide your pick-up address

The African Center cares for our elders. Please let us know if there are any additional accommodations you need (for instance, mobility assistance, language interpretation, etc.)

Submit

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