First Name

Last Name

Phone Number

Email Address

Address

Website

Full Birth Date

Social Media Handles

Name of Your Business, Non-Profit, or Project

Brief description (a small paragraph) of your organization (when was it started, size, purpose, etc.)

Describe your organization in 1-2 sentences (we may alter it if the wording is too similar to others)

Do you fulfill all three criteria? Do you fulfill all three criteria? I am a Millennial I own a business or nonprofit, or lead a significant Senior project or group I am active on social media

How often do you post on social media (organizationally, not personally)? How often do you post on social media (organizationally, not personally)? Multiple times per day Daily Weekly Monthly A few times a year

How would you describe your social media content?

What inspired you to help Seniors?

What do you most love about Seniors?

As a Millennial, how do you think your business, non-profit, or project inspires other Millennials to pay attention to, improve their opinions of, or get involved with helping Seniors?

What do you hope to gain from joining a community of Gero Infuencers?