Age Well Across Connecticut Nomination Form

Age Well Across Connecticut!

Nomination Form
We’re excited to highlight the incredible work happening in communities! From the best paved hiking trails to inclusive businesses to stellar programming, we want to hear from you! Nominate your favorite places and programs that foster or celebrate aging, disability and dementia accessibility and inclusivity.

Nominations are open year-round, due by June 30th for inclusion in the list to be released later that summer.

Each year, we’ll release a statewide list of some of the top local efforts and invite everyone to explore these local gems all year long. We publish a new list each year, but gems from prior years can be nomiated again.

Anyone can nominate and submissions are unlimited. The nomination process takes less than 5 minutes.

Selected locations will receive public recognition.

Criteria for nominees:
- Local: Connecticut based
- Established: Existing physical location or ongoing program (virtual or in-person)
- Inclusive: Designed with an aging, dementia, and/or disability lens
- Visitable: Open to the public or subset of the public
- Affordable: Free or low cost
- Community-Building - Emphasis on strengthening community and part of community fabric; goes beyond individual opportunity
Your Name:*

First NameLast Name
Your Email:*
example@example.com
Your Phone:
Please enter a valid phone number.
Name of the Nominee (business, organization, site/location, program, etc. you are nominating):*
Contact Person for Nominee:*

First NameLast Name
Nominee Email*
example@example.com
Nominee Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website of Nominee or N/A:*
Type:*

Physical locationIn-person programVirtual programOther
Open to the public or subset of the public?*

Yes
Describe your nominee and how it's intentional around aging, disability and dementia inclusivity (300 words or less). We may edit this description for publicity purposes. *

0/500
Have you personally experienced the site or program?*

YesNoOther
Topic Area (choose all that apply):*

Public Safety & PreparednessEquity, Inclusion & BelongingCommunity & Social ServicesHealth, Well-Being & Food SystemsEconomic OpportunitySocial, Cultural & Civic EngagmentPublic Space, Buildings & BusinessesTransportationHousingCommunication, Information & TechnologyNot Sure
Accessibility observed (choose all that apply):*

ADA EntranceADA ParkingADA BathroomNot SureOther
Recommended for (choose all that apply):*

Older AdultsIntergenerationalLimited mobility or disabilityLimited hearing/sight or disabilityCognitive challenges or disabilityCare PartnersOther
Anything else you'd like to add? Include your lived experience or tips for visiting this stop.*
Should be Empty:

Age Well Across Connecticut!