To: New Applicants for FY 19 Funding
From: Jennifer Roth, Executive Director
Madison County Mental Health Board
Date: July 1, 2018
Re: Funding Application Materials
In the links below you will find the forms necessary to complete the FY 19 Funding Application for New Applicants. In completing the application materials, please keep in mind the following:
- Thoroughly complete all forms, be as descriptive as possible - a Checklist has been provided below for your assistance;
- Identify a profile of individuals benefiting from local funding and clearly name service outcomes. Include local statistics/data pertinent to the unmet needs of the uninsured and underinsured Madison County residents being served. Attach any supplemental materials in support of this; and
- Please include one (1) total copy of your Form 990
The Mental Health Board continuously reviews its funding priorities as well as the cuts that have been made to core mental health, substance use disorder and developmental/intellectual disabilities services during the current year. Requests for funding should be directly tied to the unmet needs of the uninsured and underinsured populations of Madison County.
Reminder: Applications are due by 12:00p.m. on Friday, July 20, 2018.
Late applications will not be reviewed. Kindly return one (1) original and nine (9) copies of your application package to the Mental Health Board Office. Each of the ten sets of application materials should include a cover letter, all application forms , and any supplemental information for Board and Staff review. Application review meetings may be utilized as deemed necessary by Board and/or staff.
If you have any questions about the process or materials, please feel free to call the Mental Health Board office at 618-296-4357.
2019 Funding Application Forms for New Contractors:
3. Request Page
4. Cover Page
5. Expense and Revenue Forms
6. Personnel Listing Page
7. Agency Board Membership Listing Page
8. Service Plan Pages
9. General Agency Information Page
10. 2018 Poverty Guidelines
157 N. Main Street, Suite 380 Edwardsville, IL 62025 (618)692-6200 ext4357 (618)692-8986 Fax