Grant Denial Appeal Form

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

Purpose: This form is used to appeal a denial of any RCAW grant program. The RCAW Executive Committee reviews all appeals and supporting documentation. To request reconsideration, explain why you believe the denial reason identified in your denial letter is inaccurate or should be reconsidered. Appeals must be submitted within ten (10) days of receiving the denial letter and must relate directly to the denial reason.

You may upload a letter and supporting documentation as part of your appeal. Please allow up to ten (10) business days after RCAW receives a completed appeal for review and response. Submission of an appeal does not guarantee reversal of the original decision. Executive Committee decisions are final, and re-appeals will not be accepted.

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)

Group Respite Grant Program (GRGP)

Listed reason for initial denial: *

Yes

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

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