SAMPLE BUDGET ITEM/SERVICE TO BE / COLUMN TOTAL GRANT FUNDS / Microsoft / /
Currency
USD / / /
Facility
clinic Staff Volunteer Staff Volunteer Hours Last Fiscal Year Volunteer Hours Fiscal Year / Clinic Operations / Clinic Address / /
IndustryTerm
behavioral health services / bank statements / transportation / financial audits / clinic services / financial systems / pharmaceutical program fees / services / tax law / health care services / Web Address / healthcare systems / food / /
MedicalTreatment
counseling / /
Organization
Arkansas Association of Charitable Clinics / ARKANSAS DEPARTMENT OF HEALTH Center / Local Public Health office of Rural Health / office of Rural Health and Primary Care / Internal Revenue Service / Department of Health office of Rural Health and Primary Care / Arkansas State Legislature / Department of Health / National Association of Free Clinics / /
Person
Grant Requestor / Daniel Trotta / / /
Position
Governor / Executive Director / President of Board / Date Physicians Dentists Nurse Practitioners Pharmacists Behavioral Health Professionals RNs LPNs Physician / State General / Board Chairman /President / Physicians Dentists Nurse Practitioners Pharmacists Behavioral Health Professionals RNs LPNs Physician / /
ProvinceOrState
Arkansas / /
Technology
X-Ray / Information Technology / Diagnostic tests / /
Microsoft Word - NoFA Charitable Clinics[removed]ts