Dementia Caregiver Respite Grant - Grant Year 2024-2025 - Application Instructions

Sep 15, 2026

Dementia Caregiver Respite Grant application instructions for the grant year 07/01/2024 to 06/30/2025 outline eligibility, application requirements, approval timelines, and funding rules. Care recipients must be Arkansas residents with a doctor-letterhead dementia diagnosis dated within one year and stating daily assistance needs. Grant assistance is $500 per approval, limited to one open grant at a time and up to two approvals per calendar year. Funds pay respite care services only, not caregiver wages, and approved applicants must submit a Respite Survey Log within 90 days.

LanguageEnglish

CategoryForms

FormatPDF

Pages4

Reading Time2 min

AccessFree to download

Application Process

Eligibility

Application

Approval

Grant Coverage

Grant Compliance and Completion

Grant Forms Sections

Caregiver Information

Care Recipient Information

Pre-Funding Survey

Dementia Caregiver Respite Grant FOR GRANT YEAR – 07/01/2024 – 06/30/2025 Application Process Please read before applying 1.) ELIGIBILITY The care recipient (patient): • Can be of any age and must reside in Arkansas. • Must have an official diagnosis on a doctor’s letterhead of any form of Dementia. (Alzheimer’s, Parkinson’s, etc. ) The diagnosis must state that the patient requires daily assistance, be signed by the doctor or certified care physician, and dated within a year of submitting the application. 2.) APPLICATION The amount of financial assistance given per grant approval is $500 . A family may receive this grant twice in a calendar year (every 6 months between approval dates) based upon funding. Only one grant can be open at a time. The application is a total of four (4) pages, including this page; all pages and questions must be completed and answered for approval. Incomplete applications may be denied. 3.) APPROVAL The application and pre-survey must be fully completed, signed, and submitted with a diagnosis letter or prescription pad to be considered for approval. (diagnosis letters will stay on file for one year of date on letter) It may take up to 10 business days to process your application. Applications can be sent via mail, email, fax, or text. (information below) Alzheimer’s Arkansas cannot guarantee the availability of funds throughout the entire grant period. If your application is approved, you will receive a mailed approval letter, grant check, and a Respite Survey Log which should be returned within 3 months (90 days) of the approval date. 4.) GRANT COVERAGE This grant may be used to pay for respite care services ONLY. This includes services such as: • In-Home Care • Adult Daycare • Short-Term Facility Stays THIS GRANT DOES NOT PAY THE CAREGIVER (PERSON COMPLETING THIS APPLICATION) TO PERFORM THEIR DAILY CAREGIVING DUTIES. 5.) GRANT COMPLIANCE AND COMPLETION If your application is approved, you will receive a MAILED approval letter, grant check, and a Respite Survey Log. You MUST complete and return the Respite Survey Log within 3 months (90 days) of the approval date. Failure to submit the survey will subject the caregiver to being denied for all future grants offered by Alzheimer’s Arkansas. Dementia Caregiver Respite Grant FOR GRANT YEAR – 07/01/2024 – 06/30/2025 PLEASE COMPLETE EVERY PAGE (EACH PAGE IS DIFFERENT) CAREGIVER Information (unpaid person providing care to patient): Caregiver Legal Name: First Middle Last Date of Birth: / / Age: Gender: 􀂆 Male 􀂆 Female Month Day Year Gender Identity: Physical Home Address: City: State: Zip: County: Mailing Home Address: City: State: Zip: County: Phone: Email: Your answers to the following questions do not affect eligibility status of receiving this grant; however, each question must be answered. Marital Status: 􀂆 Married 􀂆 Divorced 􀂆 Separated 􀂆 Single 􀂆 Widowed Military Status: 􀂆 Active Duty 􀂆 Retired 􀂆 Veteran 􀂆 None Ethnicity: 􀂆 Hispanic or Latino 􀂆 Not Hispanic or Latino Race: 􀂆 White 􀂆 Black/African American 􀂆 American Indian 􀂆 Asian 􀂆 Hispanic 􀂆 Other Relationship to the patient: How many hours of care do you provide daily? How did you hear about this grant? Employment Status: 􀂆 Employed 􀂆 Unemployed Annual Household Income: $ Have you received a respite assistance grant in the past 12 months? 􀂆 Yes 􀂆 No If so, from where? For what kind of respite assistance are you applying? 􀂆 In-Home Care 􀂆 Adult Daycare 􀂆 Short-Term Facility Stay Your privacy is important to us, please visit [alzARK.org/grants](alzARK.org/grants) to view our full privacy statement. Are there any individuals, other than you, with whom we may share grant information? Please list in the space below: ________________________________________________________________________________________________ Dementia Caregiver

FAQs

Who is eligible to receive the Dementia Caregiver Respite Grant?

The care recipient can be of any age as long as they reside in Arkansas and have a formal dementia diagnosis on a doctor’s letterhead stating they require daily assistance. The diagnosis must be signed and dated within a year of submitting the application.

How much financial assistance is provided per grant approval, and are there limits?

Each approved grant provides $500. A family may receive this grant twice in a calendar year (every 6 months between approval dates), and only one grant can be open at a time based on available funding.

What expenses does the grant cover, and what does it not pay for?

The grant pays for respite care services only, including in-home care, adult daycare, and short-term facility stays. It does not pay the caregiver (the person completing the application) for daily caregiving duties.

Sep 15, 2026

Uploaded by Berry Peter