Thank you for your interest in TransECHO. This is an opportunity for your health center to learn from experts and apply those learnings to increase the availability of culturally-responsible, comprehensive primary care for transgender and gender non-binary people. TransECHO uses the Project ECHO model in conjunction with the application of practice transformation principles. Your health center will work alongside other health centers to create systems of care that support your transgender and gender non-binary patients.

The first TransECHO session will be January 24, 2019  from 2-4pm ET and will continue every 4th Wednesday of the month for 12 months. Participants are expected to attend every session. Applicants will be notified of their acceptance into the cohort by December 3, 2018. Accepted organizations will be required to attend a 20 minute orientation call in December.

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* 1. Are you filling this application out on behalf of another participant?

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* 2. Please enter your contact information.

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* 3. ECHO Participant Contact Information - if different from above.

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* 4. Is your organization a Federally Qualified Health Center (FQHC) or FQHC look alike?

Only FQHCs and look alikes are eligible for participation in TransECHO. If you are not sure of your status, please submit a complete application and we can be in contact about your specific situation via email.

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* 5. What is your organization's approximate practice size (as measured by annual patient visits)?

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* 6. Please describe your interest in participating in TransECHO.

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* 7. Can you describe the buy-in you have from senior leadership?

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