Create an Account - Around Town DC

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community@iona.org

Create an AccountMykal L2021-01-21T12:38:07-05:00

Create a Free Account so you can register for any of our great events!

This form is used to collect information required by the DC Department of Aging and Community Living (DACL). Collecting this information is a condition of our DACL grant which provides funding for this program. DC residents aged 60+ are eligible to create an account. If you have any questions about this form, please contact Around Town DC at community@iona.org

First Name*

Middle Name or Initial

Last Name*

Street Address:*

Suite/Apt

Zip Code*

Select Ward*

Phone Number*

HomeMobile

Work

Date of Birth*

E-mail Address*

Password*

Confirm Password*

Password must contain at least 8 characters.

Permission to add email to Around Town DC and Iona newsletters:*

YesNo

Benefits Receiving*

Commodity Supplemental Food/Farmers MarketFood Stamps/SNAP

Medicaid--Elderly and Persons with Disabilities WaiverMedicaid--Intellectual and Developmental Disabilities

Medicaid--State PlanMedicare

Public AssistanceQualified Medicare Beneficiary (QMB)

Social Security (SSA)Social Security Disability Income (SSDI)

Supplemental Security Income (SSI)Veteran's Benefits

OtherNone

Are you a member of a village? If so, which one?

The following questions ask for basic demographics information required by DACL. Please check all that apply and note that Refused is an option.

Gender Identity*

MaleFemale

TransgenderOther

Race*

African AmericanAmerican Indian

AsianNative Hawaiian or other Pacific Islander

WhiteOther

Refused

Ethnicity*

Hispanic or LatinoNot Hispanic or Latino

Refused

Primary Language Spoken*

EnglishSpanish

VietnameseKorean

ChineseFrench

AmharicAmerican Sign Language (ASL)

Other

Disability*

PhysicalMental

Physical and MentalNone

Refused

Number in Household (Optional)

Approximate Monthly Income (Optional)

Only fill in if you are not human

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WEBSITE UNDER CONSTRUCTION: Virtual class links will be sent every Monday and Wednesday. The Around Town DC team will notify you of any schedule changes. Please check your email regularly for the latest updates. If you have any questions about a class, feel free to contact us at Community@iona.org.