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2024 Dole Fellowship Application

2024 Dole Fellowship Application

Which program are you applying to?
Are you interested in learning more about our Hidden Heroes Caregiving Community?*
If so click here to join: https://hiddenheroes.org/community/registration/
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HIDDEN: Program Record Type*
Would you like to subscribe to our newsletter?
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Cohort*
First Name*
Last Name*
Email*
Phone
Street Address
City*
State*
Zip Code
Gender Identity
Ethnic/Racial Background
- American Indian or Native American
- Asian or Asian American
- Black or African American
- Latino/a or Hispanic
- White or Caucasian
- Other/Unknown
- Prefer not to say
Preferred Pronouns
Birthdate
MM slash DD slash YYYY
Have you ever served in the military?*
What branch of the military did you serve?
- Army
- Navy
- Air Force
- Coast Guard
- Marine Corps
- Space Force
- Reserve
- Guard
Caregiver Support
Please answer the following questions about your caregiving journey.
How did you hear about the Dole Caregiver Fellows Program?
Are you a caregiver to a service member or veteran?*
Are you the primary caregiver to your care recipient?
What is your relationship to your care recipient? I am the...*
Do you reside with your care recipient?
If not, please describe how you support your care recipient remotely:
Please limit to 255 characters
Do you have children?
How many children do you have?
If you have children, what has been the biggest challenge for your children during your experience as a caregiver?
Please limit to 500 words
Do you care for anyone who may qualify as a dependent?
Dependents may be friends or family, and may or may not be living in your home.
If yes, please share their name(s), birth month and year, and any special needs:
Please limit to 500 words
What year did you become a caregiver?*
How many hours per day do you spend caregiving?*
Do you participate in any VA-sponsored caregiver programs, and/or are you registered with any other government sponsored caregiver programs (e.g., at the state level)?
If yes, please identify the programs:
Please limit to 500 words
Are you involved in any other non-profit or local caregiver programs?
Do you belong to or volunteer with any organizations, institutions, or groups, particularly those with active social media, a publication or alumni network?
Examples include a specific church, university, sorority/fraternity, professional association, community group, or veterans service organization.
If yes, please identify the programs and/or groups:
Please limit to 500 words
Are you currently employed?
Are you currently in school?
If yes, can you tell us about your job and if your employer or school administrator has shown any flexibility to accommodate your schedule as a caregiver?
Please limit to 500 words
If no, did you have to leave your job or educational pursuits to provide care full-time?
Please limit to 500 words
Do you plan to move anytime within the next two years?
What, if any, support do you offer to other caregivers, either in person or online? Please describe:
Please limit to 500 words
Do you have any relationships with local politicians/civic leaders, your members of Congress, media outlets, or other organizations, particularly relationships related to your role as a caregiver?
If yes, please describe these relationships:
Please limit to 500 words
Are you involved with any organizations or projects that require you to be a spokesperson or public representative?
If yes, please describe:
Please limit to 500 words
Care Recipient Information
Care recipient first name
Care recipient last name
What is the date of birth of your care recipient?
MM slash DD slash YYYY
Care Recipient's years of service in Military:
What is the era of service for your care recipient?
Care recipient branch of military service
Current rank or rank at separation/retirement:
Type of discharge and/or retirement:
Is your care recipient supportive of you applying for this Fellowship?
Is your care recipient comfortable with you sharing details of your relationship and daily life, as it pertains to caregiving, with the Foundation, the media, and other public forums?
Care Recipient Injuries
Does your service member or veteran have a service-connected disability and/or illness?
Please describe your care recipient's service, including deployments, Military Occupational Specialty (MOS), awards/commendations:
Please limit to 500 words
Please describe the nature of your care recipients' injuries/wounds/illnesses:
Please limit to 500 words
Date(s) and location received of wounds/injury/ies/disability/ies:
Please limit to 500 words
Disability rating and/or degree of disability:
What is your care recipients primary source of healthcare? If you care recipient receives care with the VA, what city and state is the facility location?
Please limit to 500 words
Caregiver Support
Please describe the daily caregiving support you provide to your care recipient.
Is your care recipient currently employed?
If your care recipient is currently employed, please provide employer name and job title:
Please limit to 500 words
What, if any, programs and/or activities is your care recipient involved in?
Please limit to 500 words
You are meeting your congressional representative for the first time. How do you convey to him/her what being a military or veteran caregiver is like? How do you help them understand the importance of supporting military caregivers in your community and nationwide?
Please limit to 500 words
Please describe a milestone or moment that made you feel empowered or inspired as a caregiver.
Please limit to 500 words
Describe the most challenging day you have faced in your caregiving journey.
Please limit to 500 words
Write a letter to Senator Elizabeth Dole, founder of the Elizabeth Dole Foundation. Please be sure to include information on why you should be considered for this Fellowship. What sets you apart from other caregivers, and 1-2 goals you would like to accomplish as a Dole Caregiver Fellow.
Please limit to 500 words
Letter of Recommendation
Letter of recommendation link here: https://hiddenheroes.org/dole-caregiver-fellowship-recommendation/
Name
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If you need any additional information or have any questions, please contact the Elizabeth Dole Foundation or call (202) 249-7170.

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If you need any additional information or have any questions, please contact the Elizabeth Dole Foundation or call (202) 249-7170.

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