Lifespan Respite Voucher Application

Before you begin, please explain to applicant:

  • Lifespan respite funds are only awarded when other funding sources are not available
  • Respite voucher will be valid for a maximum of 90 days
  • Priority recipients are caregivers who have not had publicly-funded respite within the last 6 months

If you prefer to print and mail the voucher application, please complete and print the Voucher Application PDF in the Forms block to the right, and send it to:

High Country Area Agency on Aging
ATTN: Pat Guarnieri
468 New Market Boulevard
Boone, North Carolina 28607 

Referring Agency Information
Family Caregiver Information
Care Recipient Information
Amount of care the family caregiver provides
Background Information

*Reimbursement check will be mailed within five (5) business days of receipt of completed paperwork from caregiver.

Types of Respite Needed
Family Caregiver Certification
Referring Agency Signature