Addiction Treatment Starts Here: Primary Care - Application Submission Form

A program of the Center for Care Innovations and funded by California Department of Health Care Services and Cedars-Sinai.

Applications must be submitted by 5 pm PT on Friday, December 14, 2018. Please refer to the Addiction Treatment Starts Here: Primary Care Request for Applications (RFA) for details about the program and application requirements. 

Organizations may apply in one of two ways:

  • Option 1: your organization could submit a single application for one $50,000 grant if you are: 
    • a single-site organization; or
    • a multi-site organization applying for just one site to participate; or 
    • a multi-site organization that intends to have a single MAT team that works across multiple sites
  • Option 2: your organization could submit multiple applications for different clinic sites (up to 3) if you are a multi-site organization that plans to have separate MAT programs and distinct MAT teams at each clinic site working with different patient populations. There can be some cross-over of team members, but each site must have their own prescriber and front-line team member. If you select this option, please complete a separate application form for each applying site and submit separate application materials.

Your Organization Information

Fiscal Sponsor Information

Applying For This Grant

Site Information
Reminder: if you are applying for multiple grants, at the site level, you must complete separate applications for each clinic site. This includes a new application form and unique grant documents.

Please note that a separate application must be submitted for each site that is applying.

CEO Contact 

Program Team Lead Contact

Program Team Members

Please list the contact information for each member of your anticipated team at this site. At least 4 individuals are required to be committed to this project. Teams should include at minimum a program lead responsible for the day-to-day activities of the program, at least one x-waivered clinician, a clinical leader, and at least one other team member. See the RFA for more information about recommended team members.

Application Components

This letter should be from a senior leader that will be involved in your project (i.e.; CMO) and should be no more than 1 page.