Social Change, Innovation and Leadership (SOCIAL) Initiative Application for Leaders

SOCIAL Initiative: Working together to advance systems change

Thank you for your interest in this special opportunity.

PASWHA has developed an implementation-science project to promote Social Change, Innovation And Leadership [SOCIAL] in your work with older people living with HIV/AIDS. The purpose of this SOCIAL Initiative is to build strong cross-sector, cross system partnerships to support older people living with HIV/AIDS by educating, coaching and consulting with community leaders and helping to replicate an implementation-science based framework to promote transformational change in communities.

We will select and partner with Leaders from 8 organizations serving older clients living with HIV.

Please complete this application by September 1, 2023.

We will make our selection of leaders within the following week.

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* 1. Name

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* 2. Email address

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* 3. What is your position in your organization?

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* 4. Address of your Organization

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* 5. How long have you been employed by your organization?

Less than 1 year

Longer than 1 year, less than 3 years

Longer than 3 years, less than 5 years

Longer than 5 years, less than 8 years

Longer than 8 years, less than 10 years

Lonnger than 10 years, less than 20 years

Longer than 20 years

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* 6. Are you a PASWHA member

Yes

Other (please specify)

What are your priority systems to connect with to eliminate the barriers you described? Please rank the following systems by your interest in collaboration with them (1 = low interest in collaboration, 4 = high interest in collaboration)

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* 7. Aging Services and Systems (example: Area Agency on Aging)

0 Low Interest

4 High Interest

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 8. Housing Service Systems (example: access to low income housing assistance)

0 Low Interest

4 High Interest

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 9. Faith Based Systems (example: churches)

0 Low Interest

4 High Interest

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 10. Mental Health Systems (access to counseling)

0 Low Interest

4 High Interest

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 11. Thinking about the area of your strongest interest, what barriers have you experienced for your aging clients living with HIV to work with this system in your community?

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* 12. Do you believe change is needed?

0 No, it is not needed

10 Yes, and it is a priority that needs to happen immedidately

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 13. Do you believe change will happen

0 No, never

10 Yes, of course

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 14. How easy is it for you to create a culture and space to collaborate and partner with other organizations for change to happen?

0 Easy as pie

10 Extremely difficult

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 15. Could you describe what contributors influenced your response above?

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* 16. Can you share with us a little about who you have in mind to participate with you in this program in your own organization and community? For instance, which organizations or people do you need to connect with in order to improve the priority systems of care you rated above.

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* 17. Why do you want to be a part of this opportunity focused on social change innovation?

Thank you so much for sharing your interest with us. We will be reviewing these responses and sending out further details via email within the next few weeks.

Once you are selected to participate in this initiative, you will need to submit the following application materials:
1. Contact information
2. Confirmation of participation
3. MOU signed by your organizational director and SOCIAL Initiative leader