Glory Foundation Respite Survey
Dear Parents and Family Members,

You are being invited to participate in this survey because you are parent, or caregiver of a child in age group 0 through 21 years of age who has complex medical needs, or a life limiting illness.

The intent of this survey information is to identify the challenges faced by families who provide 24/7 care for their children and their need for respite options. This survey is necessary so that your child and family needs for respite care are validated and presented to organizations that make decisions on community respite. Your time and the information you provide via this survey is unique and very important.

Respite is planned or emergency care provided to a child or adult who is ill, or has special needs, providing a temporary break(REST) for caregivers who are providing care. We are very grateful for your time & willingness to take this survey.

Information you provide will be used:
1)to help others understand the task of providing constant care 24 hours 7 days a week
2)to influence state agencies and law makers to provide more funding opportunities for families to have respite
3) to assist organizations like The Glory Foundation, gather necessary data to prove our belief that families need to have respite.

You must be 18 or older to participate. Completion of the questionnaire will be considered your consent to participate. If you choose not to participate or to withdraw from filling this survey at any time, and your results will be discarded. The results of the survey may be published, but your name or email address will not be used at any point.

If you know another family who meets our qualifications that would like to participate in this survey, please have them email tgosha@tgfoutreach.org.Our intention is to reach as many families,who have children with complex medical needs, as possible.

Thank you in advance for completing this survey. If you would like more information about The Glory Foundation, please view our website tgfrespite.org .


Wishing you and your family all the best,
Tiona Gosha RN, BSN, MACPC, CHPPN
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