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 |