Your Name (required)

Your Email (required)

Your Phone Number (required)

The Family Caregiver's Name (required)

The Family Caregiver's Email (required)

The Family Caregiver's Phone Number (required)

Number of Years Nominee Has Been a Family Caregiver:  Less than 1 Less than 2 Between 2 and 5 More than 5 More than 10

The Nominee Cares For:  Spouse Parent Grandparent Sibling Adult Child Child Other Family Member or Friend

Tell us about the nominee:

What are the nominee's three current challenges?

How will the money the nominee receives resolve at least one of these challenges?

Please feel free to submit additional information, including photos by attaching a file.

I understand that if the nominee receives a gift of cash from CareGifters that he or she must share how the money is used and its impact by telling his or her on Caregiving.com, CareGifters.org and Your Caregiving Journey talk show.

I understand how CareGifters works.