How to Become a Respite Care Provider

If you love children, have experience caring for children with special needs, have a degree in nursing, special education, or early education, and have a flexible schedule, consider becoming a Respite Care provider.

  • Apply

    Fill out our online Application

  • Background Checks

    We will do a thorough investigation into each provider's history.

  • Authorization

    Once you have cleared your background check and completed the pre-service training, we will authorize you as eligible to provide Respite Care.

  • Matching

    We will refer you to families for an interview and follow up with monitoring and quality assurance.

  • Here for you

    We provide ongoing professional development & training as well as technical assistance to help you always provide the best level of care.

If you’re already an EFM Respite Care Provider, and have recently moved to the area, make sure to connect with The Planning Council to help new families and for the latest information and professional development.

Respite Care Provider Application

    Provider Information

    Your Name (required)

    Date (required)

    Street Address (required)

    City (required)

    State (required)

    Zip (required)

    Home Phone (required)

    Second Phone

    Your Email (required)

    Are you 18 year of age or older? (required) YesNo

    Professional Development

    College/University

    Emphasis

    Date Graduated

    Related Courses/Training

    Select all that apply. To select multiple entries click + command/CTRL.

    Other Courses Training:

    Volunteer or Work Experience

    Select all that apply. To select multiple entries click + command/CTRL.

    Other languages that you speak (including sign):

    How did you hear about this program?

    Personal care for all ages (including diapers)

    Any weight-lifting restrictions?

    Have you been convicted of, or under pending charge(s) or indictments(s) (felony or misdemeanor) wither within or outside the Commonwealth of Virginia?

    Are you a parent currently receiving respite services? YesNo

    Are you certified in CPR/First Aid (including infant/child CPR)? YesNo

    Areas of Specific Skill or Interest

    Enter number of years of experience for each item below.

    Children with autism

    Children with speech and language delays

    Children with behavior problems or behavior disorders

    Medically fragile children

    Teens

    Infants

    Other:

    Geographic Service Areas

    Select all that you are willing to serve.To select multiple entries click + command/CTRL.

    Respite Care Availabilty

    Are you currently open for respite childcare referrals? YesNo

    How many hours per month are you available to provide respite care?

    Please list all the hours and days that you are available to provide respite care services:

    Monday

    Tuesday

    Wednesday

    Thursday

    Friday

    Saturday

    Sunday

    Resume & Cover Letter

    Please upload your resume and cover letter using the upload fields below.

    Cover Letter:

    Resume:

    Are you a Family Preferred Provider? YesNo

    If so, what is the name of the family?