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 *

First & Last Name of the Applicant: *

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: *

Please provide additional details about the event leaders and facilitators, including their roles and relevant qualifications. *

Physical Event Location Address: *

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.

Is the event you plan to host financially contingent—either in full or in part—on receiving GRGP funds? Please provide a detailed explanation *

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) *

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 Disclaimer: 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

Limitation of Liability and Indemnification. If you have any questions about the legal effect of signing the document, you should consult with your own attorney.

By signing below, I agree to the following:

I recognize and agree that the Respite Care Association of Wisconsin (RCAW) does NOT provide any direct or indirect services. Further, use of RCAW’s grants does not create an employer/employee relationship, contractor/subcontractor, or any similar relationship between any person or agency using or benefiting from the grant and RCAW.

I acknowledge that RCAW is not responsible or liable for any issues that may arise from use of this grant, and I agree to hold harmless and indemnify RCAW and any of its representatives for any claims, causes of action, charges, fines, taxes, costs, liabilities, or damages that may arise from the use—or non-use—of the grant or any RCAW program, even if the application is not approved.

If I am using any part of this grant for allowed transportation costs, or if the provider or agency I hire will be transporting the care recipient, I am solely responsible for ensuring that the provider or agency providing the transportation services is properly insured. Further, I acknowledge that RCAW is not responsible or liable for any issues related to transportation that may arise from use of this grant, and I agree to hold harmless and indemnify RCAW for any claims, causes of action, charges, fines, taxes, costs, liabilities, or damages related to any transportation issues that may arise.

I understand that RCAW receives much of its funding from state and federal agencies; access to said funding may be affected by unexpected circumstances beyond its control. Such circumstances can lead to interruptions in funding, programs, or policies during the grant application process. If this occurs, RCAW will promptly notify all applicants with approved or in-process applications who may be affected.

Limitation of Liability and Indemnification. If you have any questions about the legal effect of signing the document, you should consult with your own attorney.

By signing below, I agree to the following:

I recognize and agree that the Respite Care Association of Wisconsin (RCAW) does NOT provide any direct or indirect services. Further, use of RCAW’s grants does not create an employer/employee relationship, contractor/subcontractor, or any similar relationship between any person or agency using or benefiting from the grant and RCAW.
I acknowledge that RCAW is not responsible or liable for any issues that may arise from use of this grant, and I agree to hold harmless and indemnify RCAW and any of its representatives for any claims, causes of action, charges, fines, taxes, costs, liabilities, or damages that may arise from the use—or non-use—of the grant or any RCAW program, even if the application is not approved.
If I am using any part of this grant for allowed transportation costs, or if the provider or agency I hire will be transporting the care recipient, I am solely responsible for ensuring that the provider or agency providing the transportation services is properly insured. Further, I acknowledge that RCAW is not responsible or liable for any issues related to transportation that may arise from use of this grant, and I agree to hold harmless and indemnify RCAW for any claims, causes of action, charges, fines, taxes, costs, liabilities, or damages related to any transportation issues that may arise.
I understand that RCAW receives much of its funding from state and federal agencies; access to said funding may be affected by unexpected circumstances beyond its control. Such circumstances can lead to interruptions in funding, programs, or policies during the grant application process. If this occurs, RCAW will promptly notify all applicants with approved or in-process applications who may be affected.

Typed Name as Electronic Signature: *

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This project is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,200,000 with 75 percentage funded by ACL/HHS and $400,000 and 25 percentage funded by non-government source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.

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