Scholarship for Adult Day Programs

Step 1 of 6 - Eligibility

16%

Step 1 of 6

First, let's confirm you qualify

Check each statement that is true for your situation. All six must apply to be eligible for a scholarship.

Ele 1*

My loved one has been professionally diagnosed with Alzheimer's disease or another form of dementia.

My loved one is currently living at home with me.

I am experiencing financial and/or emotional strain as a result of caregiving.

I reside in the United States.

If I applied before and was not awarded, at least 3 months have passed since my last application.

I have received no more than 2 scholarships from The Memory Connection in the past 12 months.

✓ You appear eligible. Please continue with your application. Final eligibility is determined by the Scholarship Committee.

About this scholarship: Awards cover the cost of attendance at a licensed Adult Day Program of your choice — giving your loved one engaging, safe care while you take a well-deserved break. No cash value. Applications are reviewed monthly and you'll hear back within 30–60 days.

Step 2 of 6

About you — the caregiver

Please use your own email address so you receive all communications from us directly.

Contact information

First name*

Last name*

Email address*

Phone number

Street Address*

City*

State*

ZIP*

Your caregiving role

Relationship to participant*

Employment status*

Other caregiving responsibilities

Also caring for a child

Also caring for another adult

I am the sole caregiver

No other responsibilities

(check all that apply)

Primary language spoken at home

Step 3 of 6

About your loved one

This information helps us understand their care needs and match them with an appropriate Adult Day Program.

Basic information

Full name*

Age*

Diagnosis*

Stage of dementia

Diagnosing physician

Approximate date of diagnosis

MM slash DD slash YYYY

Health & behavioral notes

Other health conditions

Behavioral considerations

Wandering risk

Sundowning

Fall risk

Agitation

Anxiety

None noted

Is your loved one currently residing at home with you?*

Yes

Is your loved one a veteran?*

Yes

Step 4 of 6

Your caregiving journey

This is the heart of your application. The review committee reads every word — the more context you share, the better they can understand your need and your story.

Tip: One or two sentences may not give the committee enough context. Please share as much as you're comfortable with — your daily experience, how caregiving has changed your life, what challenges you face. There are no wrong answers.

Your caregiving experience

Describe your caregiving experience and current circumstances*

Average hours per week spent caregiving*

Current support system

Financial & emotional hardship

Describe the financial or emotional challenges you face due to caregiving*

Does you or the participant have Long-Term Care Insurance?

Yes

Not sure

Step 5 of 6

Adult Day Program details

If you have a program in mind, share its details below. If you're not sure yet, we can help you find a licensed program near you.

Prior applications

Have you applied for a TMC scholarship before?*

Yes

No - this is my first

Received a TMC scholarship in the past 12 months?*

Yes

Proposed Adult Day Program

Program name

City of program

State

License number

Is the program state-licensed?

Yes

Not sure

Need help finding one

Days per week requested

Approximate hours of respite needed per week

Will transportation to/from the program be needed?*

Yes, transportation is needed

No, I can arrange it

Not sure yet

Step 6 of 6

Consents & acknowledgment

Please read each item carefully before responding.

Release of Information*

I give permission for The Memory Connection to contact the Adult Day Program provider listed in my application to verify licensing, enrollment, and availability on my behalf.

Yes, I consent

No, I do not consent

Optional — Story & Photo Release*

I consent to The Memory Connection sharing my caregiver story, photos, or testimonials for program awareness, donor reporting, and community outreach purposes. This is entirely optional and does not affect your application.

Yes, I consent

No, I prefer not to

Acknowledgment

Untitled*

By checking this box, I affirm that all information provided in this application is true and accurate to the best of my knowledge. I understand that scholarship awards have no cash value and cover Adult Day Program attendance costs only. I acknowledge that the Adult Day Program provider must be appropriately licensed in accordance with The Memory Connection's Scholarship Program and Policy Terms.

What happens after you submit: Your application is reviewed by our Scholarship Committee each month. You'll receive an email update within 30–60 days. Please add [email protected] to your contacts to avoid our reply going to spam

Scholarships for Adult Day Programs

About you — the caregiver

Contact information

Your caregiving role

About your loved one

Basic information

Health & behavioral notes

Your caregiving journey

Your caregiving experience

Financial & emotional hardship

Adult Day Program details

Prior applications

Proposed Adult Day Program

Consents & acknowledgment

Acknowledgment