How to Become a Respite Provider

Thank you for your interest in becoming a respite provider.  In order to become an approved provider for the Nebraska Lifespan Respite Network, please take the following steps:

  • Complete the Individual Provider Application - If you provide respite for only one family and do not wish to be referred to others, please note that at the top of the application.  The application should be mailed to WCHR/Respite, 300 Shelton Street, Chadron, Ne 69337.  Please note on your application if you are also a Medicaid approved provider.
  • Once we have received your application, an email will be sent to you from .  This is how we complete the background check process.  It is very important for you to complete the steps in the email. 
  • Please print off two Confidential Reference Check forms - you can choose to give the forms to your references and have them fill them out for you and mail with your application, or you can fill out the top portion of the form and then return it with your application and we will contact your references.
  • Log on to and create an account.  Then scroll down to the Nebraska Lifespan Respite network Provider Orientation and go through the orientation.  Once you have completed it you will receive a certificate.
  • Send a copy of your driver's license or state issued ID with your paperwork.

Getting Started with Respite Booklet

Respite Providers - Other Agencies You Can Sign Up With

We look forward to having you as one of our providers.  Feel free to contact Sherri Blome, Respite Coordinator any time at 308-432-8190 or .