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

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

Agencies must join NCRCC as a requirement of submitting this application. Membership is free. Visit the NCRCC website and click "join now" at the bottom on the home page.

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