Apply for Regional Extension Center Services

Step 1:   Download the Provider Participation Agreement.

Step 2:   Download the Provider Detail Level spreadsheet.

Step 3:  Complete and  sign the Provider Participation Agreement and the Provider Detail Level spreadsheet.  Save a copy for your records.

Step 4:  Submit your signed agreement and spreadsheet to your local community partner.  You can find your local partner by clicking on your county in the left column of this page.    

CHCA wishes to acknowledge support from the Office of the National Coordinator, Department of Health and Human Services, Award #90RC0051/01.