Group Respite Grant Program: Grant Report

Please direct questions to Rachel Watkins-Petersen (Assistant Director) by emailing [email protected]

Applicant Information

Today's Date: *

Program Name: *

Report Completed by: *

County(ies) Served: *

What was the amount of your GRGP Award? *

Beneficiary Information

(Count each participant separately. If two family members attend, count them as two individuals.)

Total number of family caregivers who attended the event(s): [enter a number only] *

Total number of care recipients who attended the event(s): [enter a number only] *

Total number of events held: [enter a number only] *

Total hours of respite provided for all events: [enter a number only] *

Total respite hours per event (multiply the number of caregivers by respite hours provided): [enter a number only] *

Care Recipient Demographics

Primary Disability: (Check all that apply) *

If you selected Other above for primary disability, please explain.

Age Group: (Check all that apply) *

Under 18

18 - 65

Over 65

Event Summary & Impact

Provide a detailed description of the event(s), including:

How the event was received by family caregivers and care recipients? *

Success stories or positive feedback: *

Challenges encountered and solutions implemented: *

Lessons learned and improvements for future events: *

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