• Apply to HCAI Funding
  • Application {% if request.params.id %} {% assign applvn = entities.eapp_applvn[request.params.id] %}{% endif %}{{ applvn.eapp_name }} – Licensed Mental Health Service Provider Education Program

Application – Licensed Mental Health Service Provider Education Program

General Information

Please list any other names you go by such as maiden names, nicknames, etc.

Are you a prior or current Office of Statewide Health Planning and Development (OSHPD) or Health Care Access and Information (HCAI) Awardee?*

As defined by Scholarship for Disadvantaged Students program, have you been identified as having a disadvantaged background based on environmental and/or economic factors, or did you receive a federal Exception Financial Need Scholarship?*

What percent of your time currently is spent working in reproductive health?*

Are you willing to continue or begin providing abortion-related care?*

Are you currently working at or are you willing to commit to serve for three years in at least one of these population areas?*
  • A health professional shortage area, as designated by the HRSA.
  • A medically underserved area or with a medically underserved population, as mapped by the HRSA.
  • A Maternity Care Health Professional Target Area, as designated by HRSA, or a maternity care desert, as designated by the March of Dimes.
  • A rural area.
  • A California county identified to have no abortion services.
  • An area where the majority of patients are covered under the Medi-Cal program.

Have you had abortion training or certification?*

If yes, from where?*

If awarded with reproductive health funds, awardees will be contacted by HCAI and a partner organization regarding opportunities related to Reproductive Health Service Corps (RHSC). Award information will be used to evaluate the effectiveness of the RHSC, unless awardees chooses not to participate by selecting the option below. If awardee chooses to participate, their information including name, email, profession, grant type, and award date will be used to contact awardees regarding these opportunities and assist with RHSC evaluation. Your information will not be shared with anyone else other than the partner organization conducting outreach and program evaluation. That entity will dispose of your information once outreach and evaluation are complete.
Please respond according to your preference.*

Do one or more of these situations apply to you?*
  • Were or currently are homeless.
  • Were or currently are in the foster care system.
  • Were eligible for the National School Lunch Program (free and reduced-price meals) for two or more years as a child.
  • Parents or legal guardians did not receive a bachelor's degree.
  • Were or currently are eligible for federal Pell Grants.
  • Received support from the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) as a parent or a child.
  • Reside or grew up in one of the following areas:
  • - A rural area, as designated by the Rural Health Grants Eligibility Analyzer. Use this link to check Rural Health Grants Eligibility Analyzer.
  • - A health professional shortage area, as designated by the HRSA.
  • - Is an individual with a disability, meaning a person with a physical or mental impairment that substantially limits one or more major life activities, as described in the Americans with Disabilities Act of 1990 (42 U.S.C. Sec. 12101 et seq.) as amended.

Do you have an existing service obligation?*

Do you currently work or volunteer for a State of California entity?*

Have you ever worked or volunteered for a State of California entity?*