Grant Denial Appeal Form

Respite Care Association of Wisconsin
www.respitecarewi.org
[email protected]
608-222-2033

Purpose: Use this form to appeal a denial of any RCAW grant program. You may explain why you believe the decision should be reconsidered and submit supporting documentation for review. All appeals must be submitted within ten (10) days of receiving the denial letter. Submitting an appeal does not guarantee reversal of the original decision. Please allow up to ten (10) business days after RCAW receives a completed appeal form for review and response.

Today's Date *

Applicant First Name *

Applicant Last Name *

Applicant's Email *

Applicant's Phone Number *

Identify the specific grant you are appealing the decision for: *

Caregiver Respite Grant Program (CRGP)

Supplemental Respite Grant Program (SRGP)

Health Meals, Health Minds Grant for Family Caregivers (HMHM)

All

Multiple, please list below

The RCAW Executive Committee reviews all appeals and any supporting documentation. Decisions are final, and re-appeals will not be accepted. Please explain why you believe the denial reason selected above is inaccurate or should be reconsidered. Your appeal must relate to the denial reason. You may upload a letter and any supporting documentation below.

Listed reason for initial denial: *

Yes, I have read and understand the Detailed Fraud Disclaimer.

Please use the space below to explain why you are appealing this denial. Be sure to address the specific denial reason selected above and include any relevant details or corrections. *

File Upload

All appeals must be communicated using this form. If you have any questions, please get in touch with [email protected].

E-Signature *

Clear

I agree to RCAW's Terms and Conditions of Use.