Regulation .02 Letter of Request.
Regulation .02 Letter of Request.LinkCopy Citation
A.
An applicant for temporary emergency funding shall submit to the Commission a letter of request outlining the need for temporary emergency funding.
B.
A letter of request shall include the following elements:
(1)
Information and documentation sufficient to establish the applicant's qualification as a community health resource as specified in COMAR 10.45.05.02, .03, or .04;
(2)
A brief description of the applicant's mission, programs, and service area;
(3)
The name, address, and location of the applicant, including the:
(a)
Name, title, address, telephone number, and email address of the director; and
(b)
Name and email address of the applicant's contact person;
(4)
The signature of an individual responsible for conducting the affairs of the applicant and legally authorized to execute contracts on the applicant's behalf;
(5)
A brief account of the organizational and financial structure of the applicant, including the applicant's:
(a)
For-profit or not-for-profit status; and
(b)
Financial stability over the 3-year period prior to the date of application; and
(6)
The nature of the program or service whose existence or funding is threatened, including:
(a)
The significance of the program or service to its target group and to the geographic area in which it operates;
(b)
The customary and usual amount of funds needed to provide the service or operate the program on a monthly, quarterly, or annual basis;
(c)
The normal or usual funding source or sources for the program or service;
(d)
The number and area of residence of low income, underinsured, or uninsured persons served by the program or service on a monthly, quarterly, or annual basis;
(e)
A concise explanation of why the temporary emergency for which funding is sought could not have been anticipated;
(f)
A concise account of any and all emergency funding requests by the applicant over the past 3 years and the results of those requests;
(g)
The specific amount of funding requested and the amount of time over which the funding will be expended;
(h)
A list of all other potential sources of funding, both internal and external, that have been approached by the applicant for this temporary emergency and their responses;
(i)
A clear explanation of how the requested funds will enable the applicant to stabilize the threatened service or program; and
(j)
Any other information that the Commission may require on the emergency grant application form.