Leadership Exchange on Ageism Scholarship Application

Be Among the First Leaders in Oregon to Participate in This Uniquely Transformative Opportunity!

The following application helps us understand how to best distribute scholarship funds. If you have any questions contact Patience Tolentino, ptolentino@ageplus.org. 

AGE+ is launching a Leadership Exchange on Ageism in Oregon to provide decision-makers, executives, policy experts, and funders with an opportunity to engage in high-level leadership development to enhance understanding of ageism and develop strategies to eliminate it. If tuition is a barrier to your participation, we'd like to learn more and work with you. This form will help us start that conversation.

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Email *
Full Name *
Organization, and Job Title or Community Role *
Phone Number *
City and County *
Which AGE+ team member have you spoken to regarding your participation in the Leadership Exchange on Ageism? *
Which LEA Session are you interested in attending?
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Addressing ageism requires a comprehensive, in-depth examination to fully understand its complexities and impact.  I have reviewed the dates of the cohort, and I am able attend 100% of LEA online sessions? *
I am willing and able to participate with my camera on.  *
If we aspire to live and work in communities and institutions that promote healthy aging for all, we must eliminate ageism.  So that we can gauge scholarship funding's impact to address age-bias in Oregon, help us understand more about your sphere of influence and community engagement. Include volunteer and unpaid community activities. *
After attending this course, what change do you hope to influence? *
Scholarship funds are limited. Full scholarships will not be awarded. LEA costs $1250 per person. How much can you and/or your organization contribute to the cost of your registration?  *
Is there anything else you would like us to know?
Thank you. 

AGE+ will review all applications on a rolling basis. Consideration will include need and DEI lens. We will notify all applicants of their status within a month of receiving this scholarship application.
A copy of your responses will be emailed to the address you provided.
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