Thank you for applying for Easterseals respite voucher program.  Please be sure you are completing the correct form.  This application is for the Lifespan Respite program.  

• If you are caring for a child under 18 with a behavioral or mental health issue, please complete the application for Child and Adolescent Caregiver Respite.
• If you are a grandparent or other non-parent relative 60 or over caring for a child under 18, please complete the application for Relative Respite.

All others, please continue with this application.   

All information and comments in this application are confidential, however, the Lifespan Respite Program and the Caregiver Resource Center are both partially funded through the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD). Therefore, we are required to share information provided in this application with DSAAPD. Additionally, applications are shared with our application review commitee to determine eligibility and funding award. 

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

• If you are assisting the caregiver with this application, please provide THEIR information, not yours.
• "Caregiver" refers to the person providing the majority of the care.
• "Care recipient" refers to the person who is receiving care. If you are caring for more than one person, a separate application is required for EACH care recipient. 
• Medical documentation will be required for each care recipient before your application will be processed.

MEDICAL DOCUMENTATION REQUIREMENT 

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

If you are unable to upload the documents, you or the medical practitioner 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 302-221-2087

Note: If we do not receive medical documentation, your application will not be processed.