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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