Pioneer Network
Returning Users  
If you are returning to update an award submission you have already started, please retrieve your information by providing your username and password below.
       Username: Password: Load Data

New Submissions  
Each award submission must have a unique username and password.
Username:    
Password:    

Community Commitment Award

Deadline for submission is April 19, 2019
Winners will be announced by May 17, 2019

Awards to be presented at the 2019 Pioneer Network Conference in Louisville on Monday, August 5.

Basic Criteria

  • At least one Resident/Elder must be actively involved in the project.  This is someone who would typically be seen as the person who is the receiver of care and services, and not the giver.
  • Program can take place in any level of care community.
  • The program must in some way be serving the greater community (town, city, state, nation) or the greater good.
  • The program must have been fully operational for at least 6 months.
  • The program must incorporate residents/elders, demonstrating hands on participation and being a part of program leadership.

Application

  • Please be sure you save your work periodically while working on this form, particularly if you will be away from your computer for an extended period of time.
  • All fields must be completed before this form can be considered for review. 
  • After completion, you will be able to print out a copy for your records.

For questions pertaining to the form or the process, please contact Misty Frank at misty@optplanning.com or call 240.481.3758. For questions pertaining to the contest or the contest criteria, please contact Joan Devine, Director of Education at joan.devine@pioneernetwork.net or 636.300.3263 or BJacobs@rockporthc.com.

Contact Person

First Name:
Last Name:
Organization:
Title:
Address of Care Community:
Address 2:
City:
State:
Zip:
Country (if other than USA)
Phone:
Cell Number:
Email Address:
Website:

Community Partner

Name:
Contact Information:

Level of Living

Adult Day Care
Affordable Housing
Assisted Living
Independent Living
Memory Care
Nursing Home
Other

Program Summary

Name of Program:
Overview of Program:

Program Development

Summary of the Program Development Process

Describe the role of the Resident(s)/Elder(s) in the development of the program?

Describe any challenges that you have had to overcome in developing your program (i.e. buy-in from the greater community, gaining the support of Residents/Elders, staff or organizational leadership, obtaining necessary funding) and how you overcame these challenges.

Resident / Elder Engagement in the Program

Who are the Residents/Elders that are involved in the program?   (include individual names or a group, i.e. 8 skilled care residents from Meadows Neighborhood.)

Describe the ongoing role of the Residents / Elders in the program?

How is this program benefiting the Residents/Elders?

Describe how you support increased Residents/Elders’ participation in the program. (i.e. a resident with significant cognitive or physical challenges or someone who may have been isolated / did not engage with others). 

Include how you used innovation, the adaptation of equipment or processes, or other means in order to support the ability of Residents/Elders to serve?

How has this project changed the way your staff, families, others perceive the value and abilities of Residents/Elders?

Community Outreach

Name of greater community partner(s) and describe this partnership.

How is this program benefiting the community at large or the greater good?

Please provide any additional information that will help us to better understand your program.

Narrative

Upload a Supporting File:
(i.e. articles, brochures, flyers)

 

Upload a Video:
(MP4, YouTube)

 


YouTube Video Link:


Click here to save your data for later editing and NOT submit for review.

Click here to submit your award submission for review.
(no updating after this point)