Apply for Addiction Treatment Starts Here: Behavioral Health

 

Before proceeding with the application, please read the program overview and confirm your organization’s eligibility to apply by reading the Request for Applications and FAQ Sheet. If you have any questions, please email us prior to the April 5 application due date.

How to Apply

Step 1: View Informational Webinar Recording (Optional)

Interested organizations are encouraged to view the recording of the informational webinar below, which reviews program components and answers questions that attendees have. You may also review the slides here.

Step 2: Submit Application Form

Applicant teams must apply via the online form by April 5, 2019. Upon reviewing applications, we may ask for follow-up information or a phone call with the applicant team lead or other leadership staff.

Please ensure you include the following documents in addition to the completed online application form:

  1. Narrative responsedownload the narrative questions
  2. Budget proposal download the budget template
  3. Letter of support from your leadership – This letter should be from a senior leader that will be involved in your project (i.e.; CMO) and should be no more than 1 page.
  4. 501(c)3 tax status documentation

 

Addiction Treatment Starts Here: Behavioral Health - Application Submission Form

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A program of the Center for Care Innovations; funded by California Department of Health Care Services.


Applications must be submitted by 5 pm PT on Friday, April 5, 2019. Please refer to the Addiction Treatment Starts Here: Behavioral Health Request for Applications (RFA) for details about the program and application requirements. 

Your Organization Information




Fiscal Sponsor Information



















Site Information
Please complete information below about the clinic site where you will be focusing your work.

Please note that a separate application must be submitted for each site that is applying.








CEO Contact 




Program Team Lead Contact






Program Team Members

Please list the contact information for each member of your anticipated team at this site. A team of 3-5 individuals are required to be committed to this project. Teams should include at minimum a program lead responsible for the day-to-day activities of the program, at least one x-waivered clinician, a clinical leader, and another team member, which could include an administrative leader, front-line care team member, or other staff central to designing and/or implementing your MAT program. See the RFA for more information about recommended team members.





Application Components



This letter should be from a senior leader that will be involved in your project (i.e.; CMO) and should be no more than 1 page.