Group Respite Grant Program Application

Frequently, a barrier for a family caregiver(s) to attend an event geared towards caregivers is a need for respite care. The Group Respite Grant Program (GRGP) funds agencies and organizations to provide on-site respite care during events for family caregivers. Examples of eligible events include support groups, educational classes, and conferences. The grant covers costs for one-time events or regularly recurring activities.

Please allow up to 14 calendar/10 business days for a formal application review.
Important Details:

Applicants must submit their applications at least 45 days before the requested funding date.
The GRGP is reviewed using an Evaluation and Grading Scale. Applications will be evaluated based on the following criteria (Total: 35 points):
- Eligibility & Compliance (5 points) – Meets submission deadlines and requirements.
- Event Purpose & Impact (10 points) – Clearly explains how the event supports caregivers.
- Respite Care & Staffing Plan (10 points): This plan defines how respite services will be provided, structured, and staffed.
- Budget Justification (10 points) – Provides a detailed, reasonable budget breakdown.
  - A minimum score of 25 points is required for funding consideration.

Applicant Information

Eligibility & Compliance (5 points)

Today's Date: *

Is your request for an event at least 45 days from today? *

Yes

Organization Name: *

FEIN#: *

Address

Street Address *

City *

State *

Postal code *

County *

Applicant's Name: *

Phone: *

Email: *

Organization's Website (If Applicable):

Event Information

(10 points) Event Purpose & Impact

Please check what best describes the event you'd like to host: *

If you selected Other above to describe the event, please explain.

Event Location: *

Event Date(s): *

Event Duration (in hours) *

Expected number of family caregivers served: *

Total respite care hours provided: (Multiply caregivers by event duration) *

Will respite care be provided at the same site as the event? *

Yes

Is this a one-time or ongoing event? *

One-time

Ongoing

If ongoing, describe frequency and duration per session: *

What specific benefits will your event provide to family caregivers? Describe how participation will support their well-being, reduce stress, increase knowledge, or enhance their caregiving experience. Please provide measurable or descriptive outcomes where possible. *

How will you promote and market this event? How will you ensure caregivers are aware that respite care will be available during the event? *

Care Recipient Information

Respite Care & Staffing Plan (10 points)

Population ages you anticipate serving: (Check all that apply) *

infant - 18

18 - 59

60 +

Expected number of care recipients served: (Enter only a number) *

Who will be the professionally paid staff members on-site? *

Number of respite care staff (paid and volunteer): *

Care recipient-to-staff/volunteer ratio: *

What specific benefits will your event provide to care recipients? What types of activities will care recipients do? Describe how participation will improve their well-being, social engagement, emotional health, or overall quality of life. Please provide measurable or descriptive outcomes where possible. *

Budget & Funding Request

Budget Justification 15 points

Funds cannot be used for expenses incurred before grant approval. Food and beverages are not allowable expenses.
Please ensure that all costs are accurately calculated and correctly totaled. Incomplete or incorrect budget calculations may result in a lower score during the evaluation process

Food and beverages are not allowable expenses. *

Yes, I understand that food and beverages are not allowable expenses.

Stipends (breakdown of staff wages, hours, and total cost): For example: We will pay five staff @ $10.00/hr. x 4 hrs. = $200 *

Materials and Supplies (detailed list and cost breakdown): *

Printing and Copying (number of copies and total cost): *

Advertising and Marketing (specific expenses and cost breakdown): *

Other expenses (be specific): *

Total grant funds requested: (Must match detailed budget items above) *

Preferred date to receive funds: *

Applicant Acknowledgement and Agreement

I have reviewed the Group Respite Grant Program Overview, Policy, and Procedure and agree to the Terms and Conditions available here: https://respitecarewi.org/wp-content/uploads/2024/11/GRGP-OPP-10.2024.pdf *

Yes

I understand that I must complete the Grant Report within 30 days after the event. *

Yes

What is the date that you agree to submit the Grant Report to RCAW? Make sure the date you enter is 30 days after the last event date. *

I attest that the information in this grant application is true and accurate and that I am authorized to sign this application on the Applicant’s behalf. *

Yes

If awarded for this grant request, who should the check be made payable to? *

If awarded for this grant request, please enter to whom the check should be addressed, including the full mailing address (street name, city, zip). *

Fraud Discalimer: RCAW funds the majority of its programs with state and federal funds. We are responsible for ensuring funds are used for their intended purpose and in a manner to conduct the goals and objectives identified in the grant. RCAW reserves the right to deny a grant application if it suspects or detects fraudulent information contained on a grant application RCAW also reserves the right to report suspected fraud to the appropriate officials, and applicants will be banned from applying for grants in the future. They may be subject to repayment of said grant funds to RCAW. All parties involved in grant fraud can potentially be charged with government grant fraud. Using state and federal grant dollars for unjust enrichment, personal gain, or other than their intended use is a form of theft, subject to criminal prosecution. I have read and understand the Grant Program Detailed Fraud Disclaimer. The link is provided here: https://respitecarewi.org/wp-content/uploads/2023/05/Grant-Program-Detailed-Fraud-Disclaimer.pdf *

Yes

Typed Name as Electronic Signature: *

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