Please help us identify community needs!

In the RESPITE program, we’re always looking at ways that we can fine-tune our programs and offerings, but more than that, we want to make sure that we are hearing from our families the ways in which we can tangibly and supportively walk with them in their caregiving journeys.

Please take a few moments to help us make sure that we have the best contact information for you and that we get an opportunity to hear about where we might be able to help meet your needs.

If you have any questions, please feel free to contact the Director of the RESPITE Program, Renae M. Dupuis, at renaed@ocunited.org.

We look forward to hearing from you!

RESPITE Needs Assessment

Step 1 of 2

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  • Is this your first assessment? Then select "Initial Intake." If you have filled this out before, but had a new need, please select "Emergent Need." If you are providing us with new information after receiving a notice, please select "Annual Follow-up."
  • Which descriptions best fit your caregiving role (select all that apply)
  • If "Other" was selected above
  • Please note if Foster (F), Adopted (A), Kinship (K), or Biological (B)
  • (years, months)
  • (FFA, county, etc.)