Generations United

Member Path

2010 IG Shared Site Excellence Awards

Organization Name
Contact Name and Title
Mailing Address
City/State
Zip Code
Daytime Phone
Fax #
Email Address
Website Address
I. Organization Background: Please include mission, primary function of the facility, key activities, demographics of the people served, and experience with intergenerational activities.
II. Describe why your shared site program should be selected as an award winner (maximum 75 words).
III. Program Details: Explain how the physical environment, activities, and daily schedule are planned to foster both formal and informal meaningful interactions among generations. Provide specifics on activities and interactions.
IV. Program Impact: Describe the impact of the shared site program (i.e. the numbers of older adults, children and youth served, the influence of the formal and informal activities on participants). Include both evaluation results and success stories.
V. Community Needs/Engagement: How does your program meet the needs of the community? How have you collaborated with or engaged the larger community in program activities?
VI. Staff Training: How are staff trained or prepared to coordinate intergenerational interactions? How do staff work in partnership with one another and with participants?
VII. Sustainability: What is your organization’s infrastructure and how have you sustained your program? What resources and services are available from your organization and other sources?
VIII. Replication: How do you document the details of your shared site (including activities, staff training, etc.) in order to ensure that the successes can be replicated by your organization and/or other shared sites in the future?
IX. Evaluation: What methods have you used to evaluate your program? What have been your primary outcomes from your evaluations?
X. Budget: Describe how you fund your shared site program.
Name of Authorized Representative
Title of Authorized Representative
Phone Number of Authorized Representative
I acknowledge that I am submitting this application with the full knowledge and consent of the authorized representative.	Yes
I have read the guidelines as outlined in the official Nomination Form and understand the requirements of this project.	Yes
I have printed out a copy of this application before hitting SUBMIT. I understand that no changes can be made after submitting the application.	Yes