Caregiver Recognition Form

Tips on Recognizing a Caregiver

• Identify the caregiver you wish to recognize. There is no limit on the number of caregivers you may choose to honor, however each must be submitted on a separate form.
• Include $25 for each caregiver submission to help defray the cost of the caregiver’s gift. If you need financial assistance to submit a caregiver for recognition, we have scholarships available to help.

Select one of the categories below that BEST suits the caregiver you wish to honor. Please do not submit the same caregiver for multiple categories.

• Family Caregiver – Provides care for an adult in their own family who is at least 23 years old or older. Family caregivers need recognition when they provide extra support and care for a spouse/partner, parent, child, sibling or other extended family members.
• Family Caregiver for Child or Youth with Special Needs – Provides care in their own family for a person 22 years old or younger.
• Volunteer Caregiver – Provides voluntary support and/or a wide range of caregiving tasks for a person or persons of any age in their home who is NOT a family member. This may include friends, neighbors or others such as those who voluntarily support hospice patients, serve as companions, provide transportation or a myriad of other caregiving duties.
• In-Home Professional Caregiver – Is employed by a company or is self-employed by the family or care receiver to provide care for a person or persons of any age in their home. This includes home health workers such as nurses, aides, and therapists, personal care attendants, hospice staff, and respite workers.
• In-Facility Professional Caregiver – Is employed by a company to provide care for people of any age in a group setting such as adult day care, nursing homes, assisted living, hospitals or rehabilitation facilities.
• Dual Life Caregiver – Provides care for a person or persons of any age in addition to being employed elsewhere full time.
• Caregiver for a Veteran – Provides care for a person of any age who is a veteran. Care for the veteran does not need to be service-related.

TIPS for Recognizing a Business or Agency

• Identify the business or agency
• Prepare a narrative about the organization
• Contact the company or agency to determine who can represent them at the 2021 Caregiver Recognition Virtual Event

An outstanding business or agency is one that provides support beyond any usual and customary requirements for its employees who also serve as caregivers for loved ones away from work. They may offer caregiver employees flexible hours and shifts, allow them to telecommute so they can work around the needs of their family members, or assist them in other ways such as finding local, community-based resources to support them in their dual roles as employees and caregivers.