Future of Aging Interest Form

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Thank you for your interest in the Future of Aging project! We are looking for the following people to participate in interviews or workshops.

- Adults 50 years or older who are D.C. residents

- Adults 18 yeas or older living with a disability who are D.C. residents

- Caregivers or people who provide regular care or support for another adult who are D.C. residents

- Professionals who work in senior services in D.C.

This research will be used to inform the Department of Aging and Community Living's work in the community and improve how the agency deliver services. The research will be on-going from May - August 2022. Participant’s information will be kept confidential and nothing you say could affect or change any services you're currently receiving.

If you're interested in being part of this important research, please fill out this form and a member of our team will contact you.

Please call 202-715-7534 or email us at futureofaging@dc.gov with any questions.

What is your first and last name? (This is optional. You can put your initials or Anonymous)

I am a... (check all that apply)

Adult 50 years or older and a D.C. resident

Adult living with a disability and a D.C. resident

Caregiver or person who provides regular support or care for another adult and a D.C. resident

Professional in senior services in D.C.

Other:

What year were you born?

What is your gender?

Female

Male

Nonbinary

Transgender

Other

Prefer not to answer

Clear selection

What is your Race/Ethnicity?

Black/African American

African

Asian

Pacific Islander

White/Caucasian

American Indian or Alaska Native

Two or More Races

Other:

Are you of Hispanic, Latino, or Spanish origin?

Yes

Clear selection

What is the primary language spoken in your home?

What neighborhood do you live in?

How do you prefer to be contacted?

Phone

Either email or phone

Clear selection

How do you prefer to participate in research activities?

Over the phone

Over Zoom or another video conferencing tool

In-person

No preference

If you prefer to be contacted by phone, what is your phone number?

If you prefer to be contacted by email, what is your email address?

Do you need any specific accommodations or assistance to participate in research activities?

Is there anything else you’d like us to know, or do you have any questions?

Submit

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