Generations United

Personal Story Form

Contact Information
Prefix
First Name
Last Name
Address
City/State
Zip Code
Phone #
Email
Caregiver's Information
Gender	Female Male Female Male
Your Age
Care Recipient's Age
I'm Caring For:	Grandchild Niece/nephew Sibling Great grandchild Other relationship Grandchild Niece/nephew Sibling Great grandchild Other relationship
Permission Statements	GU can use my story to help other family caregivers GU can post my story on the website to aid other caregivers I am willing to speak to the media about my story I would like more information about family caregiving GU can use my story to help other family caregivers GU can post my story on the website to aid other caregivers I am willing to speak to the media about my story I would like more information about family caregiving
Instructions
Each section should be no more than 250 words, written in first person.
Tell us how you became the caregiver for the child(ren) you are raising.
What are the things that you need the most, things that the government or organizations could do to help, things that would make your situation easier?
How did you hear about GU? (Check all that apply)	Colleague Website News Other Friend Colleague Website News Other Friend
Are you a GU Member?
How do you prefer to be contacted?