If you're providing care to an adult family 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 the public at large understand the challenges, rewards and complexities of caregiving in general. 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 and in promotional materials for our services.

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.

If you would prefer to share your story by phone, please email Rachel at FCA (rcreed@caregiver.org). Rachel will contact you within two business days to set up an interview.

Please tell us about your caregiving situation. This will help us to connect you with appropriate media opportunities.

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

Thank you.

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* 1. Who receives the care you provide? (For example, is the care recipient a parent, partner or friend?)

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* 2. What health condition(s) does your care recipient have? (For example, dementia, Parkinson's, heart disease, etc.)

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* 3. 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.)

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* 4. 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.)

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* 5. I consent to having FCA use my story in its communications *Required answer

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* 6. I'm open to being interviewed by FCA, reporters, or FCA's trusted partners * Required answer

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* 7. I'm open to having my photo taken:

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* 8. I'm open to being recorded (video or audio):

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* 9. Please share your email address. We never sell your contact information.

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* 10. 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.)

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