FY26 Respite Application

Respite Grant Application

10/1/2025 - 9/1/2026
Thank you for applying for Easterseals Respite Voucher Program. Please read through this application carefully and be sure that you meet the eligibilty requirements. To be eligible for our respite voucher programs, 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
These programs are funded through Older Americans Act funding, 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 this page and hit 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 302-221-2087.

Easterseals Respite Voucher Programs are 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.

Please Note: All information in this application is confidential, and shared only with necessary staff and as required by DSAAPD, the funding agency.

If you have questions, please contact our office at 302-221-2087 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 see the email, please call our office at 302-221-2087 or email resources@esdel.org and one of our staff will check if the application was received.
Who is completing this form:*

Caregiver applying for respite voucherAdult child of caregiverEasterseals staff - DLEasterseals Staff - CBEasterseals Staff - NCREasterseals staff - JSOther agency staff, i.e. hospice agency, home health agency, etc.

Do you care for another care recipient?*

YesNo

Do you care for another care recipient?

YesNo

Do you care for another care recipient?

YesNo

Do you care for another care recipient?

YesNo

Do you care for another care recipient?

YesNo

Do you care for another care recipient?

YesNo

Do you care for another care recipient?

YesNo

Do you care for another care recipient?

YesNo

If your loved one has received Easterseals services within the last two years, with your permission, we can contact that program for medical documentation and no other medical documentation is needed. By selecting the program below, you are giving us permission to contact the program. If this does not apply, please move on to next question.

Adult Day Program - New CastleAdult Day Program - GeorgetownAdult Day Program - SmyrnaTherapy Services
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 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: We need medical documentation submitted even if you submitted documentation previously. If we do not receive medical documentation, your application will not be processed.
Upload medical documentation confirming the Care Recipient's diagnosis here.

Browse Files

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Respite Voucher Program Guidelines

If you are filling out the application on behalf of the caregiver, please read the statements below exactly as they appear.
I attest that:*

All of the information in this application is true.If any information is found to be false, I understand that I could be required to repay any money provided to me as a result of providing fraudulent information.
I agree that I CANNOT be the respite provider and the person I hire:*

Will be 18 years of age or older.Will NOT be my spouse/partner, or the parent of the child or children for whom I provide care.
Notices:*

I understand that the reimbursement for respite care is made AFTER the respite has been provided.I understand that I am responsible for informing Easterseals of any changes in address, email, or telephone number.I understand that information in this application will be shared with DSAAPD as stated in the beginning of this application.I understand that if I do not provide medical documentation confirming the diagnosis of my loved one, my application will not be processed until it is received.
Should be Empty:

Respite Grant Application

Caregiver Information

Caregiving Relationship

Care Recipient Information

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Care Recipient Information

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Caregiving Relationship

Care Recipient Information

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Care Recipient Information

Caregiving Relationship

Care Recipient Information

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Care Recipient Information

Caregiving Relationship

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Respite Voucher Program Guidelines