Thank you for sharing a story of impact with NCOA! Please answer as many questions as possible. Questions? Contact community@ncoa.org
Your Details
Your Name
Your connection to NCOA
Staff
Grantee / Partner
Other
Organization Name
Story Details
Share your client story below. Adding all 3 details will make sure the story has enough context.:
1) Describe the client's circumstances BEFORE you helped them. (e.g., What was their monthly income, health status, housing status, etc.)
2) Describe the specific SERVICES that were provided to the client. (Job training, enrollment in benefits programs, educational resources, etc.)
3) Describe how the client's circumstances CHANGED because of the services they received. (e.g., How much did their monthly income grow, did their health improve, etc.)
Share your organization’s impact story below. Adding all 3 details will make sure the story has enough context.
1) Describe the unique CHALLENGE your organization was seeking to address.
2) Describe the specific INTERVENTIONS your organization took to address the challenge.
3) Describe the RESULTS of your interventions, using as much data as possible to show how it addressed the challenge.
Photo attachments
Please upload any photos or attachments you have related to this story. Photo format must be .BMP, .GIF, .JPG, .JPEG, .PNG, .TIF, .QTF. If submitting photos, please use the space below to identify each person and any instructions about crediting the photographer.
Photo Description
Topic of story
Select the topic of the story (check all that apply)
Benefits programs
Medicare Savings Programs (MSP)
Advocacy/public policy
Caregiving
Falls prevention
Medicare / Medicaid
Mental health
Personal finance / budgeting
Scams / fraud
Senior centers
What is your story about? (check all that apply.)
Financial security
Demographic Details
Client's name
Male
Female
Non-binary
Client's state
Is the client Hispanic, Latino, or of Spanish origin?
Yes
No
Don't know
What is the client's race? (Check all that apply.)
American Indian or Alaskan Native
Asian
White
Is the client a Veteran?
Please specify the branch.
Does the client have a disability?
Client's birth year (if known)
Prefer not to say
Your state
Are you Hispanic, Latino, or of Spanish origin?
What is your race? (Check all that apply.)
Are you a Veteran?
Do you have a disability?
Prefer not to answer
Your birth year
Consent Details
Are you sharing the Client's full legal name and / or photo?
Required
Upload the completed NCOA consent form here:
Optional
Confirmation and Terms
NCOA reserves the right to use stories submitted through this form in written and published materials for internal and external audiences. All stories will be kept anonymous unless a signed consent form is provided.