Thank you for your interest in the Practice Change Fellows program. Please answer the questions below to determine if you are eligible for the program.

1) Are you a (please select one):   


2) Do you work for a health organization (i.e. health plan, hospital, ambulatory clinic, home health agency, nursing home, long term care facility, or community agency) which provides health related services to older adults?
   Yes
   No


3) Do you currently hold a leadership role with a geriatric or aging related focus and have decision-making authority within your organization?
   Yes
   No


4) Do you envision your employer agreeing to support your participation in this program? Employer support includes allowing fellows to dedicate 20% of their time to the program as well as a monetary or in-kind contribution.
   Yes
   No


5) Are you able to commit two years to the program, including travel to tri-annual meetings?
   Yes
   No