Online Interest Form

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Aloha mai kākou,

Mahalo for your interest in getting involved in Hawaiʻi Dementia Initiative! Please complete this short online interest form and someone from our team will reach out to you. Feel free to call the Executive Office on Aging at (808) 586-0100 if you have any questions.

First Name *

Last Name *

Email Address *

Phone Number *

Zip code *

Which statement(s) best fit your situation?

I'm living with memory loss, Alzheimer's disease, and/or related dementia.

I'm a caregiver for a friend or family member (i.e. past or present).

I'm a volunteer.

I'm a professional who's work is related to Alzheimer's disease and related dementias issues.

My organization is affected by and/or impacts people who are living with Alzheimer's disease and related dementias issues or their caregivers.

I'm an interested community member.

Other:

How would you like to be involved?

I have a story to share.

I'd like to collaborate on the Hawai'i 2035: State Strategic Plan on Alzheimer's Disease and Related Dementias.

I'm a topic expert and would like to provide guidance.

My organization can be a partner in this work.

I'm not sure yet but I'd like to learn more.

I would like to receive email updates to stay in the loop but am unable to participate at this time.

Other:

Thank you for completing this online interest form!

We look forward to connecting with you soon.

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