47 STEPS

1. This application must be submitted by an authorized representative. Filing does not guarantee funding. Grants are awarded at B.H.C.E.F.’s discretion, based on eligibility and supporting documents.

2. “Organization legal name” is the official name of your organization as registered with the government. It appears on legal documents and tax forms—not a nickname or brand name.

3. “Trade name” is the name a business uses with the public that may be different from its legal name.

4. Select the legal structure of your organization: L.L.C. (limited liability company), Corporation, or Sole Proprietorship. Choose the option that matches how your business is formally registered.

5. Enter your organization’s official address as listed on government registration or business license. Include full street, city, state, and ZIP. Use a P.O. Box only if that’s your registered address.

6. Enter the full name of the authorized person completing this application. This should be someone legally empowered to sign on behalf of your organization, such as a director or executive.

7. Enter your organization’s Federal Tax I.D. (E.I.N.). This nine-digit number is issued by the I.R.S. and identifies your business for tax purposes. Make sure it matches what’s on your I.R.S. records.

8. Enter your organization’s State I.D. number. This is issued when you register your business with your state and is used for tax or regulatory purposes. Use the exact number from your state registration documents.

9. Enter your National Provider Identifier (N.P.I.) if your organization has one. This 10-digit number is issued to healthcare providers in the U.S. and is used for billing and identification in health systems.

10. Enter the main phone number for your organization. This should be the best contact line for official communication, typically your main office number, not a personal cell unless that’s your primary business line.

11. Enter your organization’s fax number if you use one. If not, you may leave this field blank. Provide the number exactly as it’s registered for official correspondence.

12. Enter your organization’s official website address. Use the full U.R.L. (e.g., www.example.org). If you do not have a website, leave this field blank.

13. Enter the direct phone number for the authorized person signing this application. This should be their best business contact number, not the main office line.

14. Enter the business email of the authorized person signing the application. Ensure it’s active and regularly monitored for official communication.

15. Select your care setting. Choose what matches your licensed/programmed services.

16. Enter the date your facility first began providing services under its current registration/licensure.

17. Enter your maximum licensed capacity (beds or daily slots). Use the number on your license or official approval.

18. Select Yes if you have active contracts with insurers/managed care networks. Select No if you are only out-of-network/self-pay.

19. Enter the service location address for this facility. Use the full street, city, state, and ZIP as shown on your license/registration.

20. Choose how billing is handled: In-house (your staff) or Outsourced (a billing company). Pick the current, primary method.

21. Select your accreditor (e.g., The Joint Commission, CARF, or Other). Ensure it reflects your current, valid accreditation.

22. Check all treatment tracks you offer. Only select those you actively provide. If you offer additional tracks not listed, enter them here (e.g., social media addiction, family program). Keep names clear and specific.

23. Enter the number of your staff structure (e.g. executive director, program director, physician, nurses, therapists, counselors, techs, case managers, peer support, reception, billing, H.R.). Count filled positions only.

24. Check each modality you actively provide (on-site or via documented contractors). Select only services delivered by qualified staff and available to clients in this program.

25. List any additional, clinically supported modalities you provide.

26. Select Yes if you track outcomes.

27. If Yes, briefly describe tools, timing (intake/discharge/aftercare), and what you measure. Example: ‘Standardized surveys at intake, mid, discharge, 30/90 days; reports track symptoms, function, relapse risk.

28. Select Yes if outcomes are captured during active treatment (e.g., intake, mid-point, discharge).

29. Select Yes if you collect outcomes after discharge (e.g., 30/90 days).

30. Select Yes if your system generates progress reports for each client.

31. Select Yes if reporting covers every client in the program, not just a sample.

32. Explain how you follow up post-discharge (calls, emails, alumni group).

33. Select Yes if you have an alumni program for ongoing support and engagement.

34. Explain how you track outcomes post-discharge.

35. List how you use data to improve care (C.Q.I. meetings, audits, trainings, protocol updates). Be specific.

36. Choose one fixed window: February 1–July 31 or August 1–January 31. Enter the exact start and end dates for your report.

37. Enter your licensed maximum (beds or daily slots) for this facility.

38. Enter the number of unique clients served within the selected cycle.

39. Provide a list of clients with intake and discharge dates for the chosen cycle.

40. Select Yes if you’ve ever received a B.H.C.E.F. grant.

41. Select Yes if any prior B.H.C.E.F. grant overlapped months within this reporting cycle.

42. By signing, you agree B.H.C.E.F. can verify your data, including contacting third parties like insurers or billing companies. All information is kept private and used only to review your grant request and improve research.

43. Type the full name of the person signing the application. Enter the legal name of your organization.

44. Type the full name of the person signing the application. Type the role or title of the signer, like Executive Director or Program Manager. Enter the date the form is signed.

45. List the number of extra documents you are attaching—like your census report, accreditation certificate, or outcome survey sample.

46. Finally, complete the signature section. Make sure the authorized person signs, adds their role, and lists any documents you’re submitting along with the form.

47. You’ve now completed the B.H.C.E.F. grant application. Review all sections carefully, attach your supporting documents, and submit electronically at bhcef.org. Thank you for taking the time to apply, and best of luck with your submission.