Please note that this is a two step application, followed by a medical approval. Applications will not be accepted and reviewed until the first two steps are completed, and respites cannot take place until approval is received from your medical team.
We are currently accepting applications from patients who reside in the following counties: Adams, Berks, Bucks, Chester, Cumberland, Delaware, Dauphin, Franklin, Lancaster, Lebanon, Montgomery, Perry, Philadelphia, and York. If you do not live in one of these counties, please check back regularly as our goal is to continue to expand our reach.
Policy Update: As of March 2021, AWA has instituted a limit of two respites per family so that we can use our resources to help the maximum number of families. When possible, we will assist families who have reached their respite limit find alternative support and/or resources.
Complete by Patient (Parent/Guardian)
Please begin by completing this application form. You will be asked to provide some information about the patient and the individuals who will be attending the respite. We will ask for some details surrounding your preferences for the respite, including time and destination. We will also ask about the situation surrounding the patient's illness, and why a respite is needed.Complete Form
Complete by Medical Professional
Please reach out to your medical team to complete the following portion of the application. Acceptable members of one's medical team include, but are not limited to: physicians, nurse navigators, primary care physicians, social workers, nurse practitioners, etc. If they have questions when filling out the application, have them refer to our FAQs, or contact us directly at firstname.lastname@example.org.Complete Form
A Week Away Foundation is committed to non-discrimination. It is the policy of A Week Away Foundation not to discriminate against any person applying for a Respite Week, or their family, on the basis of sex, gender; gender identity; gender expression; race; color; national origin; religion; creed; age; disability; citizenship; marital or domestic partnership status; sexual orientation; genetic predisposition; military or veteran status; or any other characteristic protected by federal, state or local law, rule or regulation.