StartUP Respite Grant Program Application

The Respite Care Association of Wisconsin (RCAW) is looking to fund new respite programs or businesses in the state of Wisconsin. One of the biggest barriers to starting a new respite program are the start-up business costs, such as facility costs, insurance, payroll, accounting, licensing, equipment, supplies, and staff education.

RCAW will be offering these funds through July 2027 because of a grant received from the Administration for Community Living (ACL) through the Federal Lifespan Respite Grant program and a partnership with the WI Department of Health Services. **

In 2023 and 2024, funds were available specifically for new programs and businesses in Milwaukee County due to the generosity of Bader Philanthropies.

ELIGIBILITY

Must be either a 1) New program or business or 2) Starting a new respite program or location as part of an existing business (expansion)

Program/Business must provide direct services in Wisconsin
A key team member of the Program/Business must have completed the Bringing Respite to Your Community (BRYC) Workshop

IMPORTANT DATES

Applications will be accepted throughout the year. Award decisions will be made quarterly (Jan, Apr, July, Oct). Programs may submit up to two applications per year. Programs that have not been previously selected will be given priority.

NOTE: You are not able to save your application and come back to it. It is suggested that you answer your questions in a word document and then copy and paste into this form. You can find the application questions here: https://respitecarewi.org/wp-content/uploads/2023/02/Start-Up-Funds-Application-Instructions.docx.

If you have questions, please contact [email protected]

**These funds are supported, in part by grant number 90LRLI0050, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201 to Wisconsin DHS. Grantees undertaking projects with government sponsorship are encouraged to freely express their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.

Today's Date *

Program Name: *

Organization name (if different from Program Name) *

Is your entity already registered with the Wisconsin Department of Financial Institutions (WDFI) https://dfi.wi.gov/Pages/Home.aspx ***Please note, IF your application is approved, RCAW requires all grantees to register with WDFI before their 6-month progress report is due*** *

Yes

If you answered YES, please provide your DFI Entity ID# (not to be confused with FEIN)

Website *

Please list the mailing address for the organization below.

Address

Street Address *

City *

State *

Country *

Postal code *

Is the organization's physical address the same as the mailing address? If not, please explain. *

First Name *

Last Name *

Title *

Email *

Phone *

A prerequisite to submitting a StartUP Respite Grant Program application is completing RCAW’s Bringing Respite to Your Community (BRYC) Workshop. https://respitecarewi.org/bringing-respite-to-your-community/ Applicants that have not completed BRYC will not be considered. Please list below: 1) Name of the person who completed BRYC and 2) Date completed. *

Amount Requested ($5,000 - $25,000) *

Program Summary: In 250 words or less, provide a high-level overview of the respite program (elevator speech). *

SPECIFIC PROGRAM INFORMATION

Please enter information regarding the specific program that the funds are being requested for. If this is a new program for an existing agency (expansion program), share information about the new program, not the already established program. Please address all of the questions asked with the open response questions, otherwise the application may be considered incomplete.

Is this a new respite program/business or a new program as an expansion of an existing direct service program/business? *

New program/business

New program/business/location as part of an existing program/business (expansion)

Answer these questions if this is a new program starting as part of an existing business. How long has the existing business been operating? How does this new program fit into the existing business? How is this new program different from existing services?

Program Model: What is the best description of your respite program model? Please check all that apply. *

If you selected Other for the best description of your program model, please explain.

What services will be offered by this program? Please use specific service billing names if known. *

Will this program need licensing or certification? Please list which licensing/certification program will receive. What is the status of the license or certification process? *

Please list the counties that your program will serve (the counties participants reside in). *

Client Population: What are the ages that this program will serve? (choose all that apply) *

Describe the client population (specific disabilities, level of care, medical needs, behavioral needs, etc.) that the program will serve. Include if there are any limitations on who you may not be able to serve (i.e., individuals with trachs, individuals who need medications, individuals who can be aggressive towards others, individuals who need assistance with toileting, etc.). *

Describe your initial program availability. Include how often and when participants will be able to use your program (what days/hours are you open, daytime or overnight care, how long is a session (# of hours) for a participant, how many sessions/hours can a participant have in a week/month, etc.). *

After a year of program operation, do you anticipate any changes to the program hours, availability and limits for participant sessions/hours, etc.? *

Facility Information: Please choose all that apply. *

This program does not provide services in a facility.

This program will rent a facility.

This program will own a facility.on 3

This program has secured a facility.

Other

If you selected Other for facility information, please explain.

What staff/volunteer-to-client ratio does the program anticipate having? *

Who are the key staff members and what are their roles? How many team members are currently involved in this program and in what roles (paid/unpaid)? *

FUNDING

For what will the requested grant funds specifically be used? *

If you selected Other for funding streams, please explain.

What is the sustainability plan for this program? Please be specific. *

ADDITIONAL INFORMATION

Need for Program: How do you know that there is a need for this program in your community? (Results of a needs analysis, letters of support from community members, caregivers, county agencies, funding sources, etc.). Supporting documentation can be attached with your budgets. *

Timeline: Provide a timeline of key milestones and dates, i.e. what needs to happen for services to start and when. *

Marketing: How will participants, families, and funding sources learn about this program? *

Additional Comments: Share any additional comments in regards to this program. *

BUDGET TEMPLATES AND SUPPORTING DOCUMENTATION

For your application to be completed, please email the following items to [email protected]. Put "Start-Up Funds Application" in the subject line.

Start-Up Budget - Template A (can be found: https://respitecarewi.org/wp-content/uploads/2023/02/Template-A-Start-Up-Budget.xlsx)
Annual Budget - Template B (can be found: https://respitecarewi.org/wp-content/uploads/2023/02/Template-B-Annual-Budget.xlsx)
Attach any information to support the need for this program in your community. This may include a needs analysis, letters of support from community members, caregivers, county agencies, funding sources, etc.

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 understand that I, as the applicant, am responsible for conducting any background checks on all staff and volunteers involved in the program and for complying with all applicable local, state, and federal laws and regulations. RCAW does not conduct, verify, monitor, or approve background checks for applicants, staff, volunteers, or participants. Applicants are responsible for maintaining appropriate supervision, safety, and screening practices for the populations served.
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.

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Applicant Signature *

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