Before You Start
Be sure you have the following documents ready before you start this application:
- Articles of Incorporation
- Federal Tax Exemption as 501(c)3
- Copy of Bylaws
- Written policy of non-discrimination on ability to pay/sliding fee scale
- Copy of current state licenses for each clinical site
- Copy of most recent financial audit
- Copies of two (2) most recent OSHPD Reports
- Copy of most recent IRS form 990
- Two (2) letters of recommendation from current CCALAC members in good standing in the same Service Planning Area (SPA)
- Electronic Logo
Please complete the application and attach all required documents.
Dues as Percentage of Clinic Budget
If you have any questions, please contact Nina Vaccaro, Chief Operating Officer.