SCHA-MI New Health Center RFP Interest Survey.
A new RFP from MDHHS is expected in the very near future. We are trying to gauge the interest in the various programs. This is a general inquiry, no commitment is being made.
1.
Name
2.
Title
3.
Organization
School District
ISD
Hospital
FQHC
County Health Department
Other
4.
E-mail Address
5.
Phone number
6.
How many school-based health centers are you interested in? (Please refer to the models of care attached to the e-mail for a description). This is a primary care provider, full-time and a full-time mental health provider.
1
2
3
4
If more than 4, please indicate what school district or school.
7.
Do you have a partnering school-district, or sponsoring agency (who provides the healthcare) in mind?
Yes
No
If no, please check the box if you would like assistance finding a partner
If yes, who is your potential partner(s)?
8.
How many mental health sites are you interested in? (Please refer to the models of care attached to the e-mail for a description). This is a full-time mental health provider only.
1
2
3
4
If more than 4, please indicate what school district or school.
9.
Do you have a partnering school-district, or sponsoring agency (who provides the mental healthcare) in mind?
Yes
No
If no, please check the box if you would like assistance finding a partner
If yes, who is your potential partner(s)?
10.
How many school-wellness program sites are you interested in? (Please refer to the models of care attached to the e-mail for a description). This is a full-time nurse and a full-time mental health provider.
1
2
3
4
If more than 4, please indicate what school district or school.
11.
Do you have a partnering school-district, or sponsoring agency (who provides the healthcare providers) in mind?
Yes
No
If no, please check the box if you would like assistance finding a partner
If yes, who is your potential partner(s)?
12.
Comment Box for additional space or questions. Thank you!
Current Progress,
0 of 12 answered
