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Agency Information
Note that this information will be visible to potential clients on our webiste










Agency Contact(s)







Services Provided





Please specify which medical supports are provided

Is your agency able to assist those seeking respite in these areas?



In order to have become a fully executed RPA the following steps will need to be completed:
  1. Submit this RPA Application with all required information.
  2. Submit the certificates of insurance with PAVE and DSHS listed according to your business requirements (e.g. General Liability or if a Sole Proprietor see your options in the Policies and Procedures, Transportation Insurance, etc.) which is available on the website via this link:
  3. Sign and submit the inter-agency agreement, as executed by the authorized agency signatory which is available on the website via this link:



Maximum file size is 50 MB




Maximum file size is 50 MB

Maximum file size is 50MB. Accepted file types are .bmp, .gif, .jpg, .jpeg, .png, .tif



If you have additional questions, contact Nincy Erazo, Program Coordinator at nerazo@wapave.org or 800-572-7368 x105, or visit the website www.lifespanrespitewa.org