HCH Grantee Update Form

Please use this form to enter any new or alternative information. Determine if our records are outdated by finding your organization in our online directory. If you have any questions, please send them to grantee update.

Contact Information
Organization Name*
HRSA or Alternate Name
Organization Phone Number
What email address should we list on your profile?

*If you prefer to keep your personal email private, list a generic email address (i.e. info@…) or enter “none”.
Organization Physical Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
If we have questions about the information provided on this form, whom should we contact? Name:*
Position
Email*
Phone
Social Media
URL Type 1
Please provide links for any social media sites on which your organization is active.
URL 1
URL Type 2
URL 2
Employees
Executive Director/CEO
Email
Phone
HCH Coordinator or Program Director
Email
Phone
Medical Director/CMO
Email
Phone
Other Leadership Staff (e.g. FInance Director, Development Director, Policy Director)

Please provide name, email, and phone.
Consumer Advisory Board (CAB) Directory
Does your program have a Consumer Advisory Board (CAB)?
- Yes, my program has a CAB.
- No, my program does not have a CAB.
CAB Staff Support Name
CAB Staff Support Role
CAB Staff Support Email
CAB Staff Support Phone
National HCH Grantee Directory
If you wish to edit the narrative description of your HCH project that appears in our online directory, or have any additional changes for this profile, please submit your revisions below.
https://nhchc.org/grantee-directory/
Services
If you wish to edit the services section of your HCH project that appears in our online directory, please submit your revisions below.
Linkages
If you wish to edit the linkages section of your HCH project that appears in our online directory, please submit your revisions below.
Statistics
Estimated homeless population:
Patients served:

Example: 1,000 in 2018
Subcontractors & Sub-Recipients
SUBCONTRACTORS & SUB-RECIPIENTS According to PIN 99-08, a SUB-RECIPIENT is “an entity (not an individual contractor) that receives a grant or a contract from a deemed health center to provide the full range of health services on behalf of the deemed health center and only for those services under the scope of the project.” A sub-recipient must also be identified as a part of the health center’s approved scope of project. All other organizations that provide individual services, such as lab tests, dental care, or pharmacy and physician services that do not fall under the definition of a sub-recipient can be considered a SUBCONTRACTOR.
If your project has subcontractors and/or sub-recipients, list their names and contact information below.
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Comments
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HCH Grantee Update Form

HCH Grantee Update Form

Contact Information

Social Media

Employees

Consumer Advisory Board (CAB) Directory

National HCH Grantee Directory

Services

Linkages

Statistics

Subcontractors & Sub-Recipients

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