Senior Centers Partnership enrollment

Thank you for your interest in Diller-Quaile’s Senior Centers Partnership Program. Please complete the following enrollment form. Diller-Quaile may use this information for grant proposals or grant reporting purposes.

Please email jpatten@diller-quaile.org with any questions.

2024-2025 Senior Centers Partnership Enrollment Form

Your Name

First Name

Last Name

Your Title/Position (i.e. Director, Coordinator)

Contact Email

Name of Senior Center

Center Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Number of individuals who attend/reside in your institution

Number of individuals that you estimate will participate in the weekly singing sessions

Number of individuals that you estimate will attend the chamber music presentations (three times per year, days and times to be arranged)

Diller-Quaile’s Community Programs are supported by public funds from the New York City Department of Cultural Affairs in partnership with the City Council, the New York State Council on the Arts, The Achelis and Bodman Foundation, The Morris and Alma Schapiro Fund, and generous donors to the Diller-Quaile Annual Fund.