PAC Organization Designation Application

PAC Organization Designation Application

We are glad your organization is choosing to pursue Positive Approach to Care® (PAC) Designation status! At PAC, we are committed to working with organizations of all sizes to grow their dementia care awareness, knowledge, skill, and competence. We look forward to partnering with you to support excellence in dementia care. This is a relationship to be built and sustained over time. Please complete this application form to get started!

Please include your specific organization name and the parent company name if applicable.
Type of Organization (overall - you may check multiple boxes if you are classified under more than one) *
Which of the following staff groups do you have in your organization (Check all that apply) *
Which staff groups regularly interact with people living with dementia ? *
Estimated percentage range of clients/residents with living with dementia in the Organization as a whole: *
Which of the following options is your organization currently using for education, training, support, or any other purpose? (Check all that apply) *
What part of the organization is applying for PAC Designation?
At least ONE Trainer is required. Please include: First Name Last Name
At least ONE Trainer is required. Please include: First Name Last Name
At least ONE Coach is required. Please note: If you are a Home Health, Hospice Agency, or Resource Organization, you may substitute a PAC Certified Consultant for a Coach.
At least ONE Coach is required. Please note: If you are a Home Health, Hospice Agency, or Resource Organization, you may substitute a PAC Certified Consultant for a Coach.
How do PAC Trainers deliver content for the part of your organization seeking Designation? (Check all that apply) *
How frequently does your PAC Trainer deliver training to staff? (For the area seeking Designation) *
Which groups of staff receive a minimum of 5 hours of PAC content per year? (Check all that apply) *
How do PAC Coaches (or Consultants) engage with staff? (Check all that apply) *
How often do PAC Coaches provide coaching to staff? *
Do coaches provide feedback using video recordings? *
Do you have additional PAC Certified staff not listed above? *
Please include: First Name - Last Name - Cert Type
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