• Caregiver/care recipient cannot be receiving any other respite services paid with federal, state or insurance funds.
• Caregiver must live full-time with or within 5 miles of the care recipient.
• Care recipient must require constant care and cannot be left alone.
• Caregiver assists care recipient with two or more qualifying daily activities; otherwise, provide more information in application.
• Family caregivers are an unpaid family member, a foster parent, or another unpaid adult who provides in-home monitoring, management, supervision, or treatment of a child or adult with a special need or chronic condition.

• A copy of your ID such as a Driver’s License
• A copy of your family member’s ID such as a Driver’s License
  • For family members under the age of 18, a birth certificate, guardianship paperwork, or student ID is acceptable.
• A completed Medical Needs Form to be completed by a provider. Please find a copy of the form here
  
• If you are interested in the $2,400 Respite Voucher option – a completed W-9 form which can be found here

Please note, your application will not be processed until we have received all corresponding documents.

Documentos requeridos para todos nuestros programas:

• Una copia de su identificación, como una licencia de conducir
• Una copia de la identificación de su familiar, como una licencia de conducir
  • Para los miembros de la familia menores de 18 años, se acepta un certificado de nacimiento, documentación de tutela o identificación de estudiante.
• Formulario de necesidades médicas. Encuentre una copia del formulario aquí
• Si está interesado en la opción de cupón de relevo de $ 2,400, necesita un formulario W-9 completo que se puede encontrar : W-9 en Español

Tenga en cuenta que su solicitud no se procesará hasta que hayamos recibido todos los documentos correspondientes.