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2026 Family Caregiver of the Year Form

2026 Family Caregiver of the Year - Nominee Profile Form

CRITERIA FOR NOMINATION 
This award is presented to a non-paid friend or family caregiver who goes above and beyond the call of duty to promote patient/client well-being and enhanced quality of life including but not limited to factors such as comfort, safety and independence.

Do not use the name of the nominee or any identifying information (such as agency name) on your narrative or in your answers.
1.Name of Nominator
2.Agency of Nominator
3.Nominator's Phone
4.Nominator's Email
5.Nominee's Name
6.Nominee's Email Address
7.Nominee's Phone Number
8.How has the caregiver made a difference in the life of their family member/friend?
9.Describe proven ability to learn care instructions and to intervene appropriately.
10.Describe adjustments made in caregiver’s personal life to provide care.
11.List other attributes pertinent to care (attitude, flexibility, dependability, willing to advocate).
12.Describe any additional reasons this nominee deserves this award over all other nominees.
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