Learning Collaborative Application

Learning Collaborative Application
Application Process

To apply for the Learning Collaborative please:
• Review the Learning Collaborative Charter: link TBD
• Complete the application questions
• Upload supplemental documents:
Network membership list, mission statement, memorandum(s) of understanding (MOU), or similar documents as applicable

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Applicant Questions
1. Applicant Organization (organization completing the application on behalf of the Community-Clinical Team members)
2. Applicant Organization Contact
3. Community-Clinical Team Members
Health System
Healthcare Provider (Clinic, FQHC, ACO, IPA, etc.)
Health Plan (List TBD if a health plan has not been determined at the time of application)
Community-Based Organization / Community Care Hub
Person With Lived Experience representing the Community

Applicant Questions