Your contact information
First name *
Last name *
Email address *
Cell phone number for text messages *
Street address *
City *
State *
ZIP Code *
Preferred contact method * Select one Email Phone call Text message
Congregation and community connection
Congregation, church, or community affiliation * Select one Plymouth United Church of Christ Pan African Orthodox Christian Church — Shrine of the Black Madonna Second Baptist Church of Detroit Another congregation or community organization I am not currently affiliated
Name of another congregation or community organization (complete if applicable)
Experience, gifts, and purpose
Why are you called to serve as a Bridging Generations Lead Innovator? *
Describe your experience supporting elders, caregivers, families, young adults, churches, or community groups. *
What leadership, organizing, teaching, technology, food, hospitality, ministry, communication, or caregiving skills will you bring? *
Which program experiences are you prepared to help lead or support? * Select all that apply.
Which Lead Innovator responsibilities are you prepared to carry? * Select all that apply.
Availability, access, and reliability
When are you generally available? * Select all that apply.
Describe schedule limitations, upcoming conflicts, or the best days and times to reach you. (optional)
Can you travel reliably to Detroit-area program locations? * What technology can you use for program communication? * Select all that apply.
Lead Innovator commitments
H2BE will use this information only to review your Innovator application, communicate about the opportunity, and coordinate selection and placement. Your application will not be displayed publicly.