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 Stacie, the Coordinator and Case Manager for RESPITE, at or Renae, the Director of Trauma and Whole-Person Care, at

We look forward to hearing from you!

RESPITE Needs Assessment 2020 Revision

  • Is this your first assessment? Then select "Initial Intake." If you have filled this out before but have 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.)
  • Section Break

  • Interview Questions

    Please fill out these questions so we can best support you through our program
  • What are the best ways that you have been supported in your journey either by agencies or groups? (i.e., various trainings, childcare services, meals, etc.):
  • How have we helped you? (if applicable)
  • Mark all that apply. If "other" is selected, please make note
  • If you selected "other," please make note here
  • Please mark all that apply. If you select "Other," please add note in the space below.
  • If you selected "Other" above, please add note here.