MAT at DHCS-Licensed Facilities Round 2

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Be sure to read the MAT at DHCS-Licensed Facilities guidelines and instructions in the Request for Applications (RFA) carefully before beginning your application. Required fields and attachment uploads are marked with a red * (asterisk).

If you have questions, send an email to centergrants@shfcenter.org with the subject line: MAT at DHCS-Licensed Facilities Application Online Help.

Use Tab key or mouse click to move from field to field.  Clicking Enter will attempt to Submit an incomplete application. 

After submission you will receive an email confirmation along with a printable PDF copy of your application.
ORGANIZATION AND CONTACT INFORMATION

This section is to be completed by the IRS qualifying organization; please use the legal name as registered with the IRS. 

Organization Contact Information
Provide the two letter state or territory abbreviation.
Organization Financial Information
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CEO/Director of the Organization

The CEO/Director should be associated with the qualifying organization above.


Financial Officer of the Organization  
The Financial Officer should be associated with the qualifying organization from the section directly above.

SPONSORED ENTITY INFORMATION 
If applying for funds through a sponsoring entity, the sponsoring entity should be the applicant organization above.  Provide information about the sponsored entity or project in the fields below and upload a signed MOU for Sponsored Projects in the project documents section.  
Provide the two letter state or territory abbreviation.
PROJECT OVERVIEW
Project Description





$
Tracks 1 & 2: Up to $550,000 for each application, dependent on facility size

Congressional District Information
Answer the following questions for the fiscally sponsored organization (the organization completing the project).


Program Contact Information

Because the project has fiscal sponsor please enter a contact affiliated with the fiscally sponsored organization to be the Primary Program Contact. This person will be contacted if there are questions or updates regarding the program.  
Application Contact Information



Additional Program Contact


Data Contact

Project Geography
Please estimate in percentages the county or counties where the work will take place. The total must add up to 100%; please adjust accordingly.

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Total must equal 100%. Please adjust accordingly.
Project Race and Ethnic Group
Estimate in percentages the race and ethnic groups that will be affected (Total must add up to 100). 

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Total must equal 100%. Please adjust accordingly.
Project Age Group 
Estimate in percentages the age groups that will be affected (Total must add up to 100).  

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Total of Age Groups must equal 100%. Please adjust accordingly.
NARRATIVE QUESTIONS






Required Attachments
Please note:  Grant applications may not be considered if requested attachments are not included or completed. 

Only upload your files with the final version. Uploading the same file many times will cause errors. If you must upload a new version of the file, change the file name.








Use Tab key or mouse click to move from field to field.  Clicking Enter will attempt to Submit an incomplete application.

An email confirming the submission of your application will be sent to the project’s primary contact.  If you do not receive an email, please contact centergrants@shfcenter.org. 
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