Become an
Alzheimer’s Association
Community Representative
Greater Illinois Chapter
Bloomington/Normal
303 North Hershey Road
Suite 2A
Bloomington, Illinois 61704
309.662.8392
Carterville
402 East Plaza Drive
Suite 4
Carterville, Illinois 62918
618.985.1095
What is an Alzheimer’s Association Community Representative (AACR)?
AACRs assist the Alzheimer’s Association in meeting community needs by:
• Delivering basic education programs
• Representing the Alzheimer’s Association at health fairs and other community events
• Speaking to community groups about the mission, programs and services of the Alzheimer’s
Association
How can I become an AACR?
• Fill out and submit the AACR application
• Attend the AACR orientation/training
What are the AACR’s responsibilities?
Chicago
8430 West Bryn Mawr Avenue
Suite 800
Chicago, Illinois 60631
847.933.2413
Joliet
1150 Essington Road
Suite 109
Joliet, Illinois 60435
815.744.0804
Rockford
1111 South Alpine Road
Suite 307
Rockford, Illinois 61108
815.484.1300
Springfield
2921 Greenbriar Drive
Suite C
Springfield, Illinois 62704
217.726.5184
www.alz.org/illinois
1.800.272.3900
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•
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Staying closely in touch with the local office staff mentor
Keeping up to date on Alzheimer’s Association news, programs, and events
Attending/delivering a minimum of four events/programs a year
Signing up public policy advocates at all events attended on behalf of the Alzheimer’s Association
What is the AACR’s expected time commitment?
• Completion of a three-hour training that covers the history and services of the Alzheimer’s
Association, and the role and responsibilities of the AACR
• Ability to commit to at least one year of service
• AACRs should expect to spend at least two hours per month working in this role
What can the AACR expect from the Alzheimer’s Association?
• A thorough three-hour initial training/orientation.
• Materials to support AACR activities
• Continuing education opportunities including access to lending library materials, online classes and
resources
• Opportunities to attend education programs, seminars, and conferences free of charge or at a
reduced rate
• A monthly conference call
About us
The Alzheimer’s Association - Greater Illinois Chapter serves 68 counties in Illinois with offices in
Bloomington, Carterville, Chicago, Joliet, Rockford and Springfield. Since 1980, the Chapter has provided
reliable information and care consultation; created supportive services for families; increased funding
for dementia research; and influenced public policy changes. Today, the Greater Illinois Chapter serves
the more than half million Illinoisans affected by Alzheimer’s disease who are in our chapter area,
including 210,000 people with the disease plus family members and caregivers.
Greater Illinois Chapter
Bloomington/Normal
303 North Hershey Road
Suite 2A
Bloomington, Illinois 61704
309.662.8392
Alzheimer’s Association
Community Representative Application
_____________________________________________________________________
NAME
_____________________________________________________________________
ADDRESS
_____________________________________________________________________
CITY
STATE
ZIP
Carterville
402 East Plaza Drive
Suite 4
Carterville, Illinois 62918
618.985.1095
Chicago
8430 West Bryn Mawr Avenue
Suite 800
Chicago, Illinois 60631
847.933.2413
Joliet
1150 Essington Road
Suite 109
Joliet, Illinois 60435
815.744.0804
Rockford
1111 South Alpine Road
Suite 307
Rockford, Illinois 61108
815.484.1300
Springfield
2921 Greenbriar Drive
Suite C
Springfield, Illinois 62704
217.726.5184
www.alz.org/illinois
1.800.272.3900
(____)__________________________(____)_________________________________
HOME PHONE
CELL PHONE
_____________________________________________________________________
E-MAIL ADDRESS
I understand that my commitment to the Alzheimer’s Association will be for a minimum of one
year service in the role of Alzheimer’s Association Community Representative. After my initial
training is complete, I agree to participate in at least four activities (speaking engagements or
health fairs) during the next 12 months.
I agree to assist my mentor in actively identifying community needs and opportunities.
I have completed the Alzheimer’s Association, Greater Illinois Chapter’s “Application-General
Volunteer” on line at http://www.alzheimers-illinois.org/volunteer/
*Please select “Alzheimer’s Association Community Rep” in the “Please check area(s) of
interest” field
Once you have completed our online general volunteer application, please submit
this form to your local office. You will then be contacted by a member of the program
staff who will assist you in registering for the next AACR training near you.
Thank you very much for your time and interest. We look forward to working with
you soon.
For office use only:
_____________________________________________________________________
Received By
Date
_____________________________________________________________________
Date of Training