Family Caregiver Registration

The SCRC Training Website will be down for maintenance this Thursday, February 15, 2018 between 1 PM and 2 PM EST. We apologize for any inconvenience.

Congratulations on taking one more step to getting the respite that you need!

Please fill out the form below to register for the Primary Caregiver training. Once you have registered, the SCRC will verify that you have been authorized to receive DDSN Family Arranged Respite services and are eligible to take the Primary Caregiver training module. Within three (3) working days of your registration, we will notify you by email that you are authorized to begin the training. If for some reason we cannot verify your eligibility, you will be notified to contact your case manager for approval or to have him or her send the approval to the SCRC.

Please complete all fields so that we will be able to communicate effectively with you and your case manager.

**Please note you only need to ever register one time

Name*
First Middle Initial Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Mailing Address?
- Mailing Address Same as Above
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Type:
Phone*
Phone Type:
Other phone
Email*

Please submit an email address that you check regularly and look for communication emails in your SPAM or Junk Folder.
County where you live
Waiver start date
Date Format: MM slash DD slash YYYY

(Enter date if known)
Who is the DSN Consumer? First, Middle, Last Name
First Middle Initial Last
DSN Consumer Birthdate
Date Format: MM slash DD slash YYYY
DSN Board where services are provided
Case Manager's Name*
First Last
Case Manager's Direct Telephone Number*
Case Manager's Email Address
Case Manager Agency*
I have chosen a respite caregiver*
- Yes
- No
Chosen Caregiver Name
First Middle Last
- I have more than one chosen caregiver
Chosen Caregiver Name
First Middle Last
- I have more than two chosen caregivers
Chosen Caregiver Name
First Middle Last
Create New Account
Username*
(alpha - numeric characters, dashes, and underscores only)
Password
Enter Password Confirm Password

Strength indicator

To strengthen password use a minimum of 8 characters with a variety of upper and lower case characters. Your password must register at least "good" on the meter above.

Family Caregiver Registration

Create New Account