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Share Your Caregiving Experience 2024

 

If you're providing care to an adult family member or friend and you're open to talking with reporters and others about your experience, please complete the survey below.

By sharing your experience as a caregiver, you can help others in our communities understand the challenges, rewards and complexities of caregiving. This in turn helps raise awareness about what's needed to support caregivers like yourself and how elected officials can shape policy that supports you and others in similar caregiving situations.

Family Caregiver Alliance might also use your caregiving stories to continue advocating for and maintaining the services and resources that you and other caregivers rely on.

This might include sharing parts of your stories in:
  • letters to elected officials
  • on our website
  • in promotional materials for our services
  • on our social media channels
  • in training videos or other training materials
  • in presentations to government agencies
  • in other materials that we create to we highlight stories about family and friend caregivers.

Please note that by sharing your story with us, you give us consent to use it in the ways mentioned above. FCA never sells your contact information.

In some cases, we might also ask you to test new technologies we're developing to support caregivers like yourself. Your ideas and feedback will help us make sure these tools meet your needs!

Your survey responses will allow us to connect you with appropriate opportunities.

If you have questions, please contact us at media@caregiver.org.

Thank you.
1.What is your name?(Required.)
2.Who receives the care you provide? (For example, is the care recipient a parent, partner or friend?)(Required.)
3.What health condition(s) does your care recipient have? (For example, dementia, Parkinson's, heart disease, etc.)(Required.)
4.What is your gender? (We ask this because we often receive requests for caregivers who are a specific gender, and your answer will help us connect you with appropriate media opportunities.)
5.*Optional* What is your ethnic or racial background? (We ask this question because we're sometimes asked to connect reporters with caregivers who are from specific racial and ethnic backgrounds. This ensures that a diversity of caregivers is represented in news articles. It can also help other family members in our communities identify themselves as caregivers and receive the resources and support they need.)
6.Are you currently employed? (We ask this because we often receive requests for caregivers who are working or who are not working, and your answer will help us connect you with appropriate media opportunities.)
7.I consent to having FCA use my story in its communications *Required answer(Required.)
8.I'm open to being interviewed by FCA, reporters, or FCA's trusted partners * Required answer(Required.)
9.Are you interested in participating in advocacy work? This might involve talking with elected officials about your experience as a family caregiver or participating as a panelist at family caregiving-focused events.(Required.)
10.Are you interested in testing new technologies focused on caregiving?
11.Below, please select the channels where you are open to having your story shared. Check boxes:
12.I'm open to having my photo taken:
13.I'm open to being recorded (audio and video):
14.Please share your email address. We never sell your contact information.(Required.)
15.* Optional * In some cases, it's more efficient for us to contact caregivers by phone. If you're comfortable sharing your phone number with us and you're open to having us contact you in this way, please enter your phone number below. We never share your contact information outside of FCA.
16.What is your zip code? (We ask this because we often receive requests for caregivers who live in a specific region, and your answer will help us connect you with appropriate media opportunities.)
Thank you!