Thank you for applying for Easterseals Moments of Rest grant program. If you have applied for the Lifespan Voucher program in the past, you will notice some changes this year.

**New this year:  funds will be awarded incrementally up to $1000 for the funding year.  However, to be eligible for additional funding, if available, you must meet the usage deadlines outlined in the approval letter you will receive.

Please read through this application carefully and be sure that you meet the eligibilty requirements. To be eligible for our respite grant program, you must meet the following requirements:

• You are an unpaid family caregiver
• You and the person receiving care are Delaware residents
• You are not receiving, or eligible for, any other respite services 

Easterseals Moments of Rest grant program is partially funded through the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) through the National Family Caregiver Support Program, Title III-E of the Older Americans Act, so one of the following age requirements must be met:

• You are caring for someone 60 years of age or older OR
• You are caring for someone with Alzheimer's disease or a related disorder OR
• You are 55 years of age or older

If you do not meet the eligibility requirements, please complete this form: Caregiver Information Form and one of our Case Managers will follow up with you.

All others, please continue reading and click next at the bottom of the page to complete the application.

Respite is anything that gives you, the caregiver, a break.  Some examples of respite include:

• taking a walk at the park alone
• attending a twice weekly yoga class
• rejoining your church choir
• spending a weekend away with friends

Respite means different things to different people.  If you have any questions about how to plan and use your respite time, please feel free to contact the office at resources@esdel.org or 302-221-2291.

 

Please Note: All information in this application is confidential, and shared only with necessary staff and as required by DSAAPD, the funding agency.  Some non-identifying information may be shared with members of the Respite Coaltion as part of this pilot program.

If you have questions, please contact our office at 302-221-2291 or resources@esdel.org  and our staff would be happy to help. 

Easterseals Privacy Policy can be found at this link:  Easterseals Privacy Policy

As you fill out this application, keep the following in mind:

1. If you are assisting the caregiver with this application, please provide THEIR information, not yours.

2. "Caregiver" refers to the person providing the majority of the care.

3. "Care recipient" refers to the person who is receiving care. 

 

Please only submit one application. Duplicate applications cause delays in processing. You will receive a "Thank you" email from Jotform letting you know that the application was successfully submitted. If you do not receive the email, please contact our office at resources@esdel.org and one of our staff will check if the application was received. 

 

 

MEDICAL DOCUMENTATION REQUIREMENT 

In order for your application to be processed, please upload current medical documentation (within 6-12 months) confirming each Care Recipient's diagnosis using the link below.

If you are applying as a non-parent relative, you do not need to send medical documentation, but please email resources@esdel.org and request the necessary form to confirm continued guardianship.

If you are unable to upload the documents, you or the physician (or nurse, therapist, etc.) can use the following methods:

Fax them to 302-414-9943
Email them to resources@esdel.org
Mail them to Easterseals Respite Program, 61 Corporate Circle, New Castle, DE 19720
Call the office at 302-221-2291
 

Note: We need medical documentation submitted even if you submitted documentation previously. If we do not receive medical documentation, your application will not be processed.

 

 

New this year:

In order for your application to be considered, you must complete the 12-question Zarit Caregiver Burden assessment.  Please click this link to complete the questionnaire:  Zarit Caregiver Burden Assessment

Be sure to come back to this form to complete and submit the application!

As a requirement of this program, please click this link to complete the Zarit Caregiver Burden Assessment:  Zarit Caregiver Burden Assessment

 

PLEASE BE SURE TO RETURN TO THIS PAGE TO SUBMIT THE APPLICATION!