WCFC-ECCS Invoice Template 25-26

WCFC-ECCS Invoice Template 25-26

Use this form to submit monthly billing for your role with the Early Childhood Comprehensive Health Systems (ECCS) project by the 5th of each month (for the previous month's activities).
Contact Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Organization or Business Name*
What month(s) are you billing for? (select all that apply)*

JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
Role*

Contract Deliverables - Status Update

Local Project Lead: Please provide a status update on your contract deliverables for the period in which you are reporting. We understand not all activities will be completed in one month's time.*

	Complete	Ongoing	Not yet started	Other
Work with Open Referral to establish a low-cost, replicable method of enabling local resource information to be exchanged with the HMG WA statewide resources and referral database operated by WithinReach
Participate in regular cohort meetings
Assess the existing local resource landscape and engage community partners in identifying priorities and resource gaps
Identify local culturally appropriate services and strategies to sustainably maintain resource information in Airtable, or other agreed upon platform
Participate in a resource exchange process to strengthen the HMG statewide resource and referral directory
Explore and document strategies to extend partnerships between the local communities and statewide systems including partners supporting early childhood and family health and well-being
Develop recommendations for sustaining and scaling the process for identifying and exchanging resources between a local community and regional/statewide directory, including an anticipated budget
Draft MOUs between cohort members and state resource databases to establish the roles and responsibilities for partnerships

Is there anything else you'd like to share regarding the ECCS activities completed during the period in which you are reporting?
Billing Amount
Use the table below to record your invoice amount. Please record separate months on individual lines. For item description, you can state "ECCS activities for [insert month]."*
Date*

MonthDayYear
Date
Signature*

Clear

Contract Deliverables - Status Update

Cohort Mentor: Please provide a status update on your contract deliverables for the period in which you are reporting. We understand not all activities will be completed in one month's time.*

	Complete	Ongoing	Not yet started	Other
Participate in WCFC Office Hours for WCFC Regions
Participate in regular cohort meetings as a mentor
Share expertise around local resource directory progress
When appropriate and agreed upon, share sample documents such as partnership agreements, meeting flows, agenda templates and work plans
Be available to individual Regions for questions and advice

Is there anything else you'd like to share regarding the ECCS activities completed during the period in which you are reporting?
Billing Amount
Use the table below to record your invoice amount. Please record separate months on individual lines. For item description, you can state "ECCS activities for [insert month]."*
Date*

MonthDayYear
Date
Signature*

Clear

Contract Deliverables - Status Update

Project Advisor: Please provide a status update on your contract deliverables for the period in which you are reporting. We understand not all activities will be completed in one month's time.*

	Complete	Ongoing	Not yet started	Other
Work with WCFC Regions to explore and assess strategies to exchange local resource information with HMG WA and other Regional/statewide resource directory systems
Facilitate WCFC-ECCS Cohort meetings
Facilitate local partner meetings with relevant regional partners, as needed
Create and share MOU, data collection tool templates, starting style guides with cohort members
Support development of a draft governance Charter and work plan, if needed
Draft a proposal for utilizing the Wilder Collaboration Factors Inventory tool to develop a framework for approaching a resource directory data exchange partnership
Support connection and collaboration between cohort participants, technology vendor, and WithinReach / WA211 staff to inform a local resource directory for information resource exchange with HMG, if deemed necessary.

Project Manager: Please provide a status update on your contract deliverables for the period in which you are reporting. We understand not all activities will be completed in one month's time.

	Complete	Ongoing	Not yet started	Other
Work with Project Facilitator, Greg Bloom & Open Referral Staff, to share ECCS activity updates at the WCFC Family Voice & Resource Access Network
Facilitate cohort meetings: create agenda, take notes, share updates
Organize Office Hours and administer office hours evaluation
Provide one-on-one coaching and support to individual WCFC Regions interested in exploring capacities to cooperate among organizations, and develop sustainable means of producing resource data that can be shared across systems
Identify and support WCFC Regions to participate in future ECCS cohort activities

Resource Management and Technical Support: Please provide a status update on your contract deliverables for the period in which you are reporting. We understand not all activities will be completed in one month's time.*

	Complete	Ongoing	Not yet started	Other
Collaborate with WCFC-ECCS communities to prepare resource directory data for exchange with HMG WA or WA211
Replicate the data comparison and analyses processes necessary for the actual exchange of resource information with HMG WA
Work with WithinReach and/or WA211 resource data management team to verify formatting and transfer
Make recommendations for future iterations of resource information exchanges between WCFC communities and HMG WA and other Regional/State resource directories

Is there anything else you'd like to share regarding the ECCS activities completed during the period in which you are reporting?
Billing Amount
Use the table below to record your invoice amount. Please record separate months on individual lines. For item description, you can state "ECCS activities for [insert month]."*
Date*

MonthDayYear
Date
Signature*

Clear

Thank you for completing this month's report!
Should be Empty: