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Community Clinic Association of Los Angeles County

Membership Application

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.

Membership Dues


Below is the structure of membership dues. If you have any questions, please contact Nina Vaccaro, Chief Operating Officer.

Year Dues as Percentage of Clinic Budget Dues Cap
FY17-18 0.18 $25,000
FY18-19 0.18 $31,500
FY19-20 0.18 $40,000