Municipal Application: Community Leaders Fellowship

Municipal Application: Community Leaders Fellowship

This is application is for the Community Leaders Fellowship program, in which a municipality partners with their older adult residents (Community Leaders Fellows) to design and implement an Ageism Awareness Day community wide project.
This application takes 10-20 minutes to complete if you have all the information and responses ready. Visit our website ctagewellcollaborative.org to preview the application questions and learn more about the Community Leaders Fellowship program.

Questions? Contact Christina.Gray@ctcommunitycare.org

Important Dates:

Applications Due: September 26, 2026

Selection Notification: October 10, 2026
Select your Municipality:
Primary Contact for Application:

First NameLast Name
Primary Contact Title
Primary Contact Department
Primary Contact Email:
example@example.com
Primary Contact Phone:
Please enter a valid phone number.Format: (000) 000-0000.
How would you describe your logistical capacity to coordinate this program?

1

2

3

4

5

1 is No Capacity, 5 is Ample
How would you describe your municipality's current work addressing ageism?

1

2

3

4

5

1 is Not Started, 5 is Advanced
How would you describe your municipality's current work addressing ableism?

1

2

3

4

5

1 is Not Started, 5 is Advanced

How active are the following resources in your community?

Rows	Very Active	Somewhat Active	Not Active	N/A
DEI Municipal Officer
Senior Center
Municipal Agent for the Elderly
Commission/Advisory on Aging
Disability Services
ADA Coordinator
Commission/Advisory on Disability

Has your municipality partnered with the Connecticut Age Well Collaborative before Check all that apply.

Other
Has your municipality partnered with other programs doing similar work? Check all that apply.

Other

Community Leaders Fellowship Application

Participation in the Community Leaders Fellowship is free to municipalities, but space is limited. Municipalities will be selected based on readiness and capacity to participate.
Briefly describe any projects or programs your municipality has done to interrupt or dismantle ageism? (Up to 200 words)

0/200
Why do you want to participate in the community leaders fellowship? (Up to 200 words)

0/200
Are you open to Community Fellows who live, work, and play in other municipalities contributing to your Ageism Awareness Day project?
Municipal Fellows: This program requires three high level municipal leaders who each commit to dedicating 40 hours over the course of the fellowship. Municipal fellows can be elected officials, staff, or formally appointed commission members. Have you already identified the municipal fellows who will represent your municipality?
Municipal Fellow 1
Municipal Fellow 2
Municipal Fellow 3
End of Community Leaders Fellowship Application Questions
Thank you for taking the time and energy to apply for a Community Leaders Fellowship.

Please click "submit" to complete your application.
Should be Empty:

Community Leaders Fellowship Application