
1
Smart
Growth
and
Active
Aging
National
Recognition
Program
Introduction
Definitions:

*
Smart
Growth
(
SG):
Smart
Growth
is
defined
as
development
that
serves
the
environment,
community,
economy,
and
public
health.
The
principles
of
smart
growth
include:
1)
Mix
land
use;
2)
Take
advantage
of
compact
building
design;
3)
Create
a
range
of
housing
opportunities
and
choices;
4)
Create
walkable
neighborhoods;
5)
Foster
distinctive,
attractive
neighborhoods
with
a
sense
of
place;
6)
Preserve
open
space,
farmland,
natural
beauty,
and
critical
resources;
7)
Strengthen
and
direct
development
towards
existing
communities;
8)
Provide
a
variety
of
transportation
choices;
9)
Make
development
decisions
predictable,
fair,
and
cost
effective;
10)
Encourage
community
stakeholders
collaboration
in
development
decisions.

*
Active
Aging/
Physical
Activity
(
PA):
includes
planning
and
implementing
a
variety
of
widely
accessible
programs
and/
or
self­
directed
opportunities
for
those
60+
and
which
emphasize
activities
that
increase
endurance,
strength,
flexibility,
balance,
and
the
principles
of
injury
prevention.
These
types
of
activities
include
walking,
biking,
fitness
trails
and
similar
activities/
programs
at
various
levels
of
intensity
to
fit
the
capacities
of
participants.

*
Community
assessment
or
survey:
can
include
formal
needs
assessment
or
community
survey
or
discussion
of
community
needs
with
service
providers
with
smart
growth
or
active
aging/
physical
activity
programming
or
opportunities
in
the
community.
To
be
completed
by
applicant:


I
have
reviewed
the
accompanying
policy
and
activity
components
that
are
integral
to
the
smart
growth
principles
above,
and
understand
that
they
should
form
the
basis
for
our
community's
responses
to
the
application
items
for
the
Smart
Growth
and
Active.
Aging
National
Recognition
Program.

Paperwork
Reduction
Act
Burden
Statement
The
public
reporting
burden
for
filling
out
this
questionnaire
form
is
estimated
to
average
one
hour
per
response.
This
includes
time
for
reading
the
instructions
and
providing
the
requested
information.
Send
comments
on
the
Agency's
need
for
this
information,
the
accuracy
of
the
provided
burden
estimate,
and
any
suggested
methods
for
minimizing
respondent
burden,
including
through
the
use
of
automated
collection
techniques,
to
the
Director,
Collection
Strategies
Division,
U.
S.
Environmental
Protection
Agency
(
2822T),
1200
Pennsylvania
Ave.,
NW,
Washington,
D.
C.
20460.
Include
the
OMB
control
number
in
any
correspondence.
Do
not
send
the
completed
form
to
this
address.
2
OMB
Control
No.:
2090­
New
EPA
Form
No.:
XXXX
Expiration
Date:
xx/
xx/
xx
Questionnaire
1.
Our
community
has
defined
goals
or
a
mission
for
advancing
or
applying
*
smart
growth
principles.


Not
at
all

Partially
completed

Fully
Completed
2.
Our
community's
governing
body
has
conducted
or
commissioned
a
*
community
assessment
for
applying
*
smart
growth
principles.


Not
at
all

Partially
completed

Fully
Completed
3.
Our
community
has
defined
goals
or
a
mission
for
increasing
older
adult
participation
in
*
active
aging/
physical
activity.


Not
at
all

Partially
completed

Fully
Completed
4.
Our
community's
governing
body
has
conducted
or
commissioned
a
*
community
assessment
of
older
adult
participation
in
active
aging/
physical
programs
or
opportunities.


Not
at
all

Partially
completed

Fully
Completed
5.
Our
community
has
developed
a
plan
that
includes
feasibility,
costs,
and
impacts
of
adopting
a
smart
growth
approach
to
plan
for
the
future.


Not
at
all

Partially
completed

Fully
Completed
6.
Our
community
has
studied
the
feasibility,
cost,
impacts,
time
frame
and
leadership
for
creating/
promoting
active
aging/
physical
activity
for
aging
adults.


Not
at
all

Partially
completed

Fully
Completed
7.
Our
community
is
actively
engaged
in
formulating
plans
and
strategies
for
specifically
linking
smart
growth
initiatives
with
programs,
amenities
or
opportunities
that
include
active
aging/
physical
activity
for
older
adults

Not
at
all

Partially
completed

Fully
Completed
3
8.
Our
community
has
established
interagency
committees,
task
forces,
or
other
community
partnerships
with
local
aging
organizations,
service
providers,
and
agencies
as
a
means
of
coordinating
activities
and
programs
with
smart
growth
and
active
aging/
physical
activity
components.


Not
at
all

Partially
completed

Fully
Completed
9.
Our
community
has
legislative,
zoning,
comprehensive
plan
initiatives
and
other
policies
in
place
or
in
consideration
that
include
provision
for
both
smart
growth
and
active
aging/
physical
activity
programs
or
opportunities
for
older
adults.


Not
at
all

Partially
completed

Fully
Completed
10.
Our
community
has
created
pilot
programs,
or
has
existing
programs
for
active
aging/
physical
activity
for
older
adults
which
take
advantage
of
the
resources
and
environments
created
by
local
smart
growth
activities
such
as
safe
walking
area,
biking
amenities,
age­
sensitive
exercise
trails,
safe
parks,
etc.


Not
at
all

Partially
completed

Fully
Completed
11.
Our
community's
comprehensive
planning
integrates
smart
growth
principles
and
promotes
application
of
these
to
encompass
active
aging/
physical
activity
programs
and
opportunities
for
older
adults.


Not
at
all

Partially
completed

Fully
Completed
12.
Our
community
is
increasing
its
capacity
through
actions
such
as
budget
allocation,
staff
resources,
infrastructure
improvement,
etc.
for
systematically
expanding
on
smart
growth
activities.


Not
at
all

Partially
completed

Fully
Completed
13.
Our
community
is
reaching
out
to
local/
county/
state
officials
and
departments,
land
developers,
and
community
organizations
to
expand
smart
growth
activities.


Not
at
all

Partially
completed

Fully
Completed
4
14.
Our
community
includes
gathering
evidence
about
and
evaluating
the
effectiveness
of
and
level
of
participation
in
our
active
aging/
physical
activity
programs
and
opportunities
for
older
adults.


Not
at
all

Partially
completed

Fully
Completed
15.
Our
community
has
an
initiative
that
includes
promotion,
advertising,
recruitment,
and
widely
available
programs
and
opportunities
to
engage
more
older
adults
in
active
aging/
physical
activity.


Not
at
all

Partially
completed

Fully
Completed
16.
Our
community
has
the
capacity
to
implement
a
model
program
combining
smart
growth
principles
with
programs
emphasizing
active
aging/
physical
activity
for
older
adults.


Not
at
all

Partially
completed

Fully
Completed
17.
Our
community
has
a
well­
established
smart
growth
initiative
and
active
aging/
physical
activity
programs
and
opportunities.

18.
Our
community
is
planning
to
expand
these
to
a
wider
segment
of
our
population
as
well
as
the
partnerships
that
will
support
these
programs.


Not
at
all

Partially
completed

Fully
Completed
19.
Our
community
has
an
established
coalition
of
service
providers,
advocacy
organizations,
businesses
and
governmental
agencies
who
are
cooperating
to
create
more
innovative
and
widely
available
programs
that
integrate
smart
growth
principles
and
active
aging/
physical
activity
programs
and
opportunities.


Not
at
all

Partially
completed

Fully
Completed
20.
Our
community
has
an
existing
model
program
integrating
active
aging/
physical
activity
and
smart
growth
for
older
adults
and
we
can
provide
technical
assistance
and
a
contact
person
to
share
information
with
other
communities.


Not
at
all

Partially
completed

Fully
Completed
5
Applicant
completing
this
questionnaire
Name:
_____________________________________

Title:
_______________

Organization:
_____

Address:
__________
___________________________________________

City:
_________,
State__________
Zip:________

Phone:
___________
Fax:___________

Email:
____________________
