JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Caregiver Community Feedback
Thank you for viewing our United Ways of California Caregiver Support online page. We appreciate your feedback on a few things to assist our progress of this Caregiver Support program. Thank you in advance.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Please check the appropriate box to give permission to share your responses confidentially. If you allow some permission, it helps to confirm program gaps in your county.
*
I give permission to United Ways of California to share my story without any confidential information about myself.
I give permission to United Ways of California to share my image, name, or story
I do not give any permission to United Ways of California
Required
What language is your preference for information?
Choose
English
Spanish
Other
What County do you reside in?
*
Your answer
On a scale of 1-5, how satisfied are you with the list of resources available in the United Ways of California caregiver support online page?
*
Not Satisfied
1
2
3
4
5
Extremely Satisfied
The content was organized and easy to follow
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
I believe the content was relevant and useful for a caregiver's journey
*
Strongly agree
Agree
Neutral
Disagree
Strongly Disagree
Are you familiar with AARP Caregiver resources?
*
Yes
No
Maybe
What type of resources are you looking for?
Basic Needs - Includes food, housing/shelter, material goods, transportation, and utilities
Criminal Justice and Legal Services - Includes domestic violence programs
Health Care
Income Support and Employment
Individual and Family Life
Disaster Services
Mental Health - Includes substance use disorder services and crisis services
Veterans and Military Families
Youth Services
Older Adult Services
If you gave permission to share with United Ways of California
- Please share your caregiver journey and what would be helpful to other caregivers in California.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of United Ways of California.
Report Abuse
Forms
