Daring Dialogue Municipal Program Application

  • Municipal Program Application

    Thank you for your interest in disrupting ageism and ableism in your community! This is a common application for our Daring Dialogues and Community Leaders Fellowship programs. Use this form to apply for one or both programs. We accept applications on an ongoing basis and review them in monthly batches. Selection is based on readiness and capacity.

  • 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 Daring Dialogues and the Community Leaders Fellowship programs.

    Questions? Contact Christina.Gray@ctcommunitycare.org

  • Format: (000) 000-0000.
  • Which programs are you applying for? Check all that apply.*
  • Rows
  • Has your municipality partnered with other programs doing similar work? Check all that apply.*

  • Daring Dialogue Application

    Daring Dialogue are free to municipalities, but space is limited. Municipalities will be selected based on readiness and capacity to host.
  • Co-Applicants: Are you planning on hosting your Daring Dialogue in collaboration with other municipalities?*
  • Availability: Daring Dialogues are 2.5 hour in-person workshops. Programs are available during normal business hours. Is this timing feasible for your community?
  • Location: Daring Dialogues must be held in a fully ADA accessible space that hold at least 40 people. Do you have a location identified?*
  • Recruitment Team: Daring Dialogues need a team of three to recruit 15-30 participants across multiple municipal departments and representing different segments of your community. Have you already identified the members of your recruitment team?*
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  • Are you interested in sending 2-4 representatives to the Daring Dialogue Facilitator Training?*

  • End of Daring Dialogue Application Questions

  • 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.
  • Co-Applicants: Are you planning on sponsoring a cohort of Community Leaders Fellows in collaboration with other municipalities?*
  • Scope: Have you already identified a key challenge or project that needs the lived experience of older adults, people living with dementia, people with disabilities, and their care partners. ?*
  • Are you open to Fellows who live, work, and play in other municipalities contributing to your project?*
  • Municipal Leaders: Community Leaders Fellowship success needs at least two high level municipal leaders who each commit to dedicating 20 hours over the course of the fellowship. Municipal leaders can be elected officials, staff, or formally appointed commission members. Have you already identified the municipal leaders who will collaborate with fellows?*

  • End of Community Leaders Fellowship Application Questions

  • Thank you for taking the time and energy to apply for a Connecticut AgeWell Collaborative's Daring Dialogue and/or Community Leaders Fellowship.

     

    Please click "submit" to complete your application. 

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