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* 1. First and Last Name:

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* 2. Overall, how satisfied or dissatisfied are you with the application process of RCAW's Caregiver Respite Grant Program?

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* 3. Did you find the processes involved in applying for assistance via the Caregiver Respite Grant program user friendly?

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* 4. Were you happy with the respite you received as a result of RCAW's Caregiver Respite Grant Program?

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* 5. What did you do with your 'respite' time?

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* 6. How likely are you going to apply to the Caregiver Respite Grant Program again?

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* 7. What are the top three (3) challenges that you have as a family caregiver?  Select up to three answers.

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* 8. Did the Caregiver Respite Grant Program help or relieve any of the challenges you identified above?

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* 9. Do you have any other comments, questions, or concerns?

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* 10. Any suggestions on what we can do to improve our Caregiver Respite Grant Program?

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