Clone of Muhammad Ali Center Youth Program Application 2025-2026

Ali Center Elders Program Application

Thank you for your interest in joining the Ali Center Elders program. This program brings together older adults to build meaningful connections and share wisdom to improve Louisville. You do not need any special experience to apply, just a willingness to participate at the Ali Center.
Full Name

First NameLast Name
Age
E-mail
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Race/Ethnicity
Are you a veteran?
What is your current living situation?
Can you arrange transportation to the Ali Center for biweekly meetings on Tuesdays from 11:30 AM to 1:30 PM?
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Do you have any accessibility needs we should be aware of?

How connected do you currently feel in Louisville?

	1	2	3	4	5

1 is Not At All Connected, 5 is Very Connected

What makes it hard to feel connected in Louisville?
Why are you interested in joining the Ali Center Elders Program?
What do you hope to get out of participating in this program?
What issues in Louisville do you care deeply about?
Are you able to attend regularly scheduled meetings on biweekly Tuesdays from 11:30 AM to 1:30 PM?
Do you consent to participating in the Ali Center elders program and for your application information to be used for program purposes?
Should be Empty:

Ali Center Elders Program Application