National Family Caregivers Association

Friday Nov 20, 2009

Family Caregiver Story Project

Contact Information

* Required Fields

Please create you unique user ID and password for the Story Project. This will allow you to update your Story, change your e-mail, or change your permissions for people to view your story whenever you wish. If you have already submitted a story, your username will be your e-mail address and your password will be your last name:

UserName:*
Password:*

Prefix:

First Name:*

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Email Address:*

Daytime Phone:*

Home Phone: (If different from Daytime Phone)

Caregivers' Information

Your Sex:*	Female Male

Your Age:*

Care Recipient's Age:*

I am caring for my:*

Living Arrangements:*	My care recipient lives with me

	I am a long distance caregiver - care recipient is on their own

	Care recipient is in an assisted/nursing/other facility

	Other

Primary Illness:*

Family Caregiver’s Condition:*	Depression

	Relationship Issues

	Financial Issues

	Work Issues

	Positive Aspects of Caregiving Experience

Permission Statements

	I give permission for NFCA to add my story to its caregiver story database and use it for legislative, educational and media purposes to help all family caregivers.

	I am willing to speak to newspaper or magazine reporters about my story.

	I am willing to speak to radio and television reporters about my story.

	I would like to receive emails from people interested in being a Pen Pal with me after reading this story.
Instructions Stories should be no more than 250 words, written in first person. Three sample stories are included for your information. Begin with a brief paragraph or two about your situation. Please include: Your first name, your loved one's first name and your relationship Your age and sex Your loved one's age Your care recipient's condition (i.e. Alzheimer's Disease, Spinal Cord Injury) Tell how long you have been a caregiver and other specifics about your situation. (i.e. whether or not you receive help-- paid or unpaid, your concerns and fears, the positive aspects of your caregiving experience as well as your frustrations).
To see sample stories written by other family caregivers, click here.

Enter your story here:


Now make a list of your caregiving needs (a wish list). To view an example, click here. What would make caregiving easier or more manageable for you? How could the government (state or federal) help? What do you find yourself wishing for?
Please number your needs and wishes; no more than six.