Get Project Choices Fasd Initiative - Year Iii Provider Application - Oasas

This guide provides step-by-step instructions to assist users in completing the Project CHOICES FASD Initiative - Year III Provider Application online. By following these clear and supportive directions, users can ensure a thorough and accurate submission.

Follow the steps to effectively complete your provider application.

1. Select the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling in the provider information section. Enter your provider name, number, address, phone number, fax number, and email. Ensure all details are accurate for communication purposes.
3. Identify the chemical dependency program you propose for participation in Project CHOICES by completing the PRU name, number, and address if it differs from your main provider address.
4. Provide your application contact person's name, title, phone number, fax number, and email address for further queries.
5. In section A, describe your agency’s qualifications to participate in Project CHOICES, and detail how your participation will enhance services for female patients.
6. Indicate your agency's experience with FASD prevention and whether you provide birth control or contraceptive education. Use additional pages if required.
7. In section B, specify your agency's involvement with Motivational Interviewing by selecting the appropriate level of implementation and training.
8. Detail your agency’s past experience with sponsored projects in section C, including any current or planned projects and staff involvement.
9. In section D, identify key individuals involved in the project and describe their roles and the resources they can allocate.
10. Complete section E regarding IT and Internet access, specifying the internet speed and accessibility for relevant staff.
11. Once all sections are filled out, carefully review the application for accuracy and completeness.
12. Finally, submit the application along with a signed cover letter to the specified address by the deadline.

Complete your Project CHOICES FASD Initiative provider application online today to ensure your agency's participation.