Thank you for applying for an Easterseals respite voucher program.  Please be sure you are completing the correct application.  This form is for the Relative Respite program.  To be eligible for the Relative Respite Program:

• you must be  60 years of age or older (new age this year)**
• the child or children for whom you provide care must be 17 years of age or younger
• you must have primary responsibilty for the care of the child or children
• you must be related to the child or children by blood, marriage, or adoption. 

**Please note:  if you previously qualified for the Relative Respite Program because you were 55 or over, you will still qualify.  

All information and comments are confidential, however, the Relative 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, regardless of the age of the care recipient, we are required to share information provided in this application with DSAAPD. 

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

• If you are assiting the caregiver with this application, please provide their information, not yours. 
• "Caregiver" refers to the person providing the majority of the care
• To be eligilbe for this grant, you must be the person who provides the majority of the child/children's care. 
• Copies of birth certificates will be required for each child before your application will be processed. 
• Documentation showing that the child/children live with you is also required.

In this section, we'll gather some information about the children for whom you provide care. You'll need to fill out all of the information for each child. Start with the oldest child receiving care.

REQUIRED DOCUMENTATION

In order for your application to be processed, please upload the brith certificates of each child below along with documentation showing that the child/children live with you.

If you are unable to upload the documents, you 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 the birth certificates or documentation, your application will not be processed.

If you do not have copies of the birth certificates, please call our office at 302-221-2087.