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Providing Care
Interested in Providing Care?

Are you interesting in providing care for children with disabilities and their families in the Dane County area? Your help is very much needed! Please complete the following information about yourself and a LINK representative will follow up as soon as possible regarding available care opportunities.

Please note: Fields noted with the red asterisk (*) are required.
Your Name:*
Street Address:*
City / State / Zip:*
Phone:*
E-mail address:*
Referred by:
Type of care interested in providing:* Respite - Family Home
Respite - Provider Home
Personal Care Worker
Inclusion Facilitator - Center/School Based
Inclusion Facilitator - Community Based
Teen Mentor
Event Volunteer
Therapy Provider
Availability:* Weekdays
Evenings
Overnights
Weekends
Commitment:* 1 year
Summer only
One time event
Unsure
Have access to a car:* yes no
Do you speak Spanish:* yes no
Please tell us about your training and experience:*
Children/Adults with Disabilities:
Other Child Related Care:
Other Employment:
Education/Degree:
Do you have any plans which may change your ability to proceed with the application process?
Comments:

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