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.
Annual Dues as Percentage of Clinic Budget
Annual Dues Cap
If you have any questions, please contact Nina Vaccaro, Chief Operating Officer.