Interest Form: Certification for Medical Respite Care Programs

Please complete this interest form to initiate the process of pursuing certification through the National Institute for Medical Respite Care (NIMRC), a special program of the National Health Care for the Homeless Council (the Council).

Medical Respite Care (MRC) programs who submit interest forms can expect to hear from our NIMRC certification team within two weeks of the application window closing. MRC programs assigned to an open spot will receive orientation materials and an invitation to a consultation meeting where NIMRC certification specialists will address preliminary questions, provide additional information about the process/expectations, and confirm the MRC program’s intention to formally seek certification. When applicable, eligible MRC programs may be notified that all available spots have been filled. We will keep such MRC programs well-informed about future application windows, so they can re-apply at the next opportunity. They may also be placed on a temporary waitlist in case a new spot unexpectedly becomes available.

We appreciate your grace and patience as we navigate this complexity.

Application Deadline:

Please complete the interest form below before the application window closes at 12:00 pm (Central Time) on April 15th, 2025.

Name*
First Last
Job Title*
Email Address*
Phone Number
Medical Respite Program Name*
Operating Agency Name*
City*
State*
Has your Medical Respite Program been operational and actively serving medical respite clients for at least one year?*
- Yes
- No
Is your Medical Respite Program listed (with up-to-date information) in NIMRC's Directory of MRC Programs?*
If unsure, you can view the current Medical Respite Care Directory here. If "no," please complete a program profile form before submitting this interest form.
- Yes
- No
Please tell us why you are interested in pursuing certification. How are you hoping this will impact your Medical Respite Care program?*
Does your Medical Respite Program have capacity to designate a small team of staff members to complete the certification process (we recommend a team of 2-5 people)? The Medical Respite Program’s certification team should be prepared to spend roughly 40-60 hours total on certification activities over a six-month period.*
- Yes
- No
Please tell us which staff members you hope to include in your Medical Respite Program's "certification team" and any other plans for ensuring that certification activities will be fully completed.*
Note: We recognize your plan will likely change as you learn more about the process. We simply want to see that you've given thoughtful consideration to the investment of staff time and effort.
Please provide the name and job title of a senior administrator in your organization who affirms your responses to the two items directly above and endorses the submission of this interest form.*
Note: This may or may not be the same person completing this interest form.
Is there any additional information you'd like to share with us that you feel is relevant?
Acknowledgement
By submitting this form, you are formally expressing your interest in pursuing certification for your Medical Respite Program. A member of our team will notify you (via email) within 14 days of this application window closing whether you have been matched to an open spot.

Medical Respite Programs assigned to an open spot will receive orientation materials and an invitation to an individual consultation meeting where we will address preliminary questions, provide additional information about the process/expectations, and confirm that your Medical Respite Program would like to move forward and formally seek certification.

If we don't have capacity accept your application at this time, we will keep you well-informed about future application windows, so you can re-apply at the next opportunity. Your program may also be placed on a temporary waitlist in case a new spot unexpectedly becomes available.

We appreciate your grace and patience as we navigate this complexity.
I understand.
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Interest Form: Certification for Medical Respite Care Programs

Interest Form: Certification for Medical Respite Care Programs

Application Deadline:

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