Senior Planet Licensing Program Application

Thank you for your interest in Senior Planet's licensing program for in-person learning experiences! The application process is as follows:

Attend an Information Session
Submit the application form

If you haven't attended an Information Session, please register for an upcoming session here.

We will review your application and inform you of our decision within 3-4 weeks.

Application Details

All questions are required unless otherwise noted.
Organizations operating in the United States, Puerto Rico, and the US Virgin Islands are eligible to apply.
Applications will be reviewed on a rolling basis.
Questions about the application or the application process can be directed to licensing@seniorplanet.org.
To ensure you receive communications from us, please add licensing@seniorplanet.org to your contact list. This will help prevent our emails from being directed to your spam folder.

Organization Information

Organization Legal Name

EIN Number

If you do not have an EIN Number, please explain.

Website

Primary Contact First Name

Primary Contact Last Name

Primary Contact Title

Primary Contact Email

This is the email that will be used to contact you regarding the status of your application. Please add licensing@seniorplanet.org to your safelist to ensure you receive communication from us.

Primary Contact Phone Number

Phone

Organization Details

What term best describes your organization?

Tell us about your organization. What is your mission? Your area of focus?

What states/US territories does your organization serve?

If you operate in more than one state/territory, please select the primary state/territory where you intend to offer Senior Planet classes.

Counties

Please list the county/counties where you intend to teach Senior Planet classes.

Affiliations

Is your organization affiliated with a broader initiative or system (e.g., library systems, religious organizations, multi-site nonprofits)? If so, please briefly describe the structure and your organization’s role within it.

Staff and Volunteers

How many full-time and part-time employees do you have?

Client/Service Reach

Please estimate the number of individuals your organization serves in a typical year.

Geographic Profile

Please provide a description of the geographic area your program serves. Include information about the region’s unique characteristics, challenges, and socioeconomic context (such as broadband access, educational opportunities, and income levels) that impact your work.

Do you serve any of the following populations?

Please select all that apply.

Senior Planet Licensing Program

How did you hear about Senior Planet?

What impact would bringing Senior Planet to people age 50+ in your area have?

Projected Class Participants

How many participants do you anticipate hosting in your Senior Planet classes during the first year of the program?

Program Administrator

Does your organization have someone who will fill the role of the program administrator of the Senior Planet licensing program?

Administrator Details

Briefly detail your plan(s) to fill the role of the program administrator. If you do not have someone who can fill the role, please describe what your organization would need to do so.

Trainer(s)

Does your organization have at least one person who would serve as the trainer for your Senior Planet programs?

Trainer Details

Briefly detail your plan(s) to fill the role of the trainer(s). If you do not have someone who can fill the role, please describe what your organization would need to do so.

Devices & Internet

Does your organization have access to a classroom set of 8-15 devices and internet speed capable of hosting Senior Planet programs?

Device Details

Briefly detail the devices you have available. If you do not have devices, please describe your plans to acquire them.

Classroom Space

Does your organization have access to a classroom space capable of hosting Senior Planet programs?

Classroom Details

Briefly describe the space(s) you have available. If you do not have space, please share your plan to acquire space.

Do you currently offer technology programs for seniors?

Do other organizations offer technology programs for older adults in your service area or community?

Please identify any risks, challenges, or hurdles that you might encounter if you join the Senior Planet licensing program.

Consider any specific local, cultural, or organizational factors that could impact the program's success.

Do you have any additional comments or information to share?

Send me a copy of my responses

Report Abuse

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.