Caregiver Outreach Program Referral

United Way of North Carolina’s NC 211 is partnering with AARP to support caregivers through the Caregiver Outreach Program. This program offers one-on-one phone calls with a dedicated and trained NC 211 Navigator that provides;

Supportive listening
Referrals to resources based on your request and needs
Follow up calls regarding referrals to discuss any issues or additional needs
Calls arranged to meet your schedule

Please fill out the form below. Once submitted, a Navigator will reach out to the associated caregiver to complete an intake appointment. If you would like assistance please call 2-1-1 or 1-888-892-1162 and request the Caregiver Outreach Program.

Required Fields*

Who is referring the caregiver?*

Caregiver's Basic Information

Full Name*

Phone Number*

Preferred Language*

Zip Code*

Situational Information

Are there any aspects of this caregiving experience that would be helpful to know before a staff member from NC 211 reaches out? Either about the caregiving experience or about the person being cared for.

Demographic Information

Age*

Pronouns

Other

Are you a veteran?*

Referrer Information

Referring Agency*

Your Full Name*

Your Phone Number*

Your Email

What is your relationship to the caregiver?*

Caregiver has consented to providing this information and being contacted by NC 211 through their Caregiver Outreach Program*
Yes