Caregiver University

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Caregiver University Application Form

November 5-15, 2024

2025 Dates:

February 4-14, 2025
June 10-20, 2025
September 16-26, 2025
November 4-14, 2025

Last Name *

First Name *

Middle Initial *

Preferred Name (what you like to be called) *

Address Line 1 *

Address Line 2

City/State/Zip *

Email Address *

Primary Phone Number *

Alternate Phone Number

Please choose the answers that best describe your current dementia caregiving situation. *

I provide in-home care to a relative who is living with Alzheimer's or another type of dementia

I care for my relative full-time (we live together)

I care for my relative part-time and provide intermittent care (3 times a week or less)

I provide in-home care to someone I am not related to

I am the primary caregiver

I provide care with support from siblings, in-home care professionals, or other support service

I have never used support services

I anticipate providing care to someone with Alzheimer's or another type of dementia in the near future

Please describe your current caregiving situation in 100 words or less. *

Please describe what you hope to learn or accomplish through the training. *

Please describe how you learned about Caregiver University. *

Please describe your internet access and available electronic equipment to participate in the virtual training (PC, laptop, tablet, mobile phone, webcam) *

Caregiver University is provided by The MIND (Memory Impairment and Neurodegenerative Dementia) Center at the University of Mississippi Medical Center.