If you have questions about this form or need assistance filling it out, please contact Betsy Paniagua, bpaniagua@yamhillcco.org

Basic Funding Guidelines:
Service Integration Team dollars are intended to meet an immediate, one-time need that achieves a measurable outcome towards health, wellness, and/or self-sufficiency. SIT funds are a last resort when all other community resources have been accessed or unavailable. Funding requests are situation-dependent, but not more than $300.
Measurable Outcomes:
Service Integration funds should be focused on meeting needs that can provide some measurable outcomes (whether big or small).

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* 1. Referring agency/Provider contact information

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* 2. Individual/family contact information

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* 3. Type of request: E.g. car repair, utility assistance, rent assistance, etc. 

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* 4. Please provide a detailed description of what the funds will be used for. What is the family/individual's circumstances?

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* 5. Indicate the number of people who will be served because of funding. If activity was for a large group, estimate the total number.

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* 6. What is the individual's plan to pay for this expense the next time it's due?

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* 7. Outstanding balance of bill

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* 8. Amount of funding being requested? (Please provide a specific $ amount. No more than $300)

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* 9. Which resources have you already accessed?

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* 10. Please list how much money each resource has provided

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* 11. Is this request urgent? If so, please contact Betsy at bpaniagua@yamhillcco.org after filling out this request. 

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* 12. If your request is not urgent, it will need to be presented to the SIT that you are requesting money from. Please contact bpaniagua@yamhillcco.org to request SIT calendar and confirm your presentation.

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* 13. What SI Team are you requesting funds from? (You may select more than one) 

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* 14. What services/resources is the individual/family receiving?

Thank you.
If you have questions about this form or need assistance filling it out, please contact Betsy Paniagua at bpaniagua@yamhillcco.org

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