Y-ICSI Request for Participation

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Organization Name* This field is required.

4

Briefly describe your organization/program* This field is required.

5

How do you define or understand the concept "Intergenerational"? * This field is required.

6

Have you participated in, or practiced any intergenerational program/group/activity?* This field is required.

Yes

No

Unsure

7

If yes, what was it? Briefly describe it.

8

Is there a problem you think could be explored intergenerationally? Briefly explain your thoughts.* This field is required.

9

What are you most interested in? (Select all that apply)* This field is required.

Developing something

Partnering with others

Learning and gaining resources

Partnering with the Ypsilanti Senior Center

10

Why are you interested in this work?* This field is required.

11

Do you have any links, or examples of work you'd like to share with us?

12

Which workshop are you interested in attending?

January

February

Both