New Tribal Pathways

PATHWAYS TO COMMUNITY LIVING GRANT APPLICATION
This application is a collaborative effort between Oklahoma Health Care Authority and potential Tribal Governments.
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Applicant(Tribe) *:

Mailing Address:
Point of Contact:
Phone:
Email:
Secondary Contact:
Secondary Contact Phone:
Secondary Contact Email:

Fill in below italicized areas
Background Narrative Tribe to include history of tribe and relevant programs

Statement of need Tribe to include what the gaps are that these funds would help fill, potential Impact, stakeholders, etc.

Proposed Project Goals & Deliverables Tribe to include goals and list out deliverables to achieving those goals, include timeline

Target Demographics Tribe to include who the recipients will be of the changes, OHCA can help provide statistics

Collaboration with County, State & Federal Stakeholders Tribe to include plan for collaboration with partners

Budget and Budget Justification Tribe to include breakdown of costs, justifications, and total requested amount, include breakdown per year of grant dollars requested

Sustainability Plan Tribe to include plan for sustaining efforts in place post funding, Include Medicaid, or third-party Insurance enrollment