Service Integration Forms

Team Member Forms
 

Form Name When Do I Use This?
Online Funding Request To request funding from an SI Team, a completed request form must be submitted at least one day prior to the next regularly scheduled meeting date 

For questions regarding Funding Requests please contact fco.service.integration@co.polk.or.us

SI Funding Reporting Form

Partners who receive funds from Service Integration must complete a SI Funding Reporting Form.

Staffing: Release of Information
(updated April 2019)

A signed Release of Information must be obtained for all Service Integration Funding Requests, or if staffing will include personal or identifying information. 

Instructions:

1. Please have the client complete all sections highlighted in yellow; the releasing agency should complete all sections highlighted in green. Both client and representative from releasing agency must sign the form.

2. Scan signed ROI and email fco.service.integration@co.polk.or.us