Dementia-Friendly Online Resources Survey
Thank you so much for using this form to submit information about programs and services provided by your organization that are available ONLINE for people living with dementia and family care partners. This survey will take no longer than 5-10 minutes to complete.

If you would like to submit information about more than one program, please submit a separate form for each one.

If you would like to send us supplemental materials about the program (such as program flyers and promotional materials), please email them to Dementia Friendly Nevada AmeriCorps VISTA Mekai Smedley at

We look forward to featuring information about your ONLINE programs and services on the Dementia Friendly Nevada website!
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Organization Details
In this section, please provide information about your organization.
Please list the primary organization offering the program. *
What is the mission statement of this organization? (optional)
Primary contact's name: *
Primary contact's email: *
Primary contact's phone:
Primary contact's role within organization:
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