Application Content. Each application shall include the following information:

(a)

The type of assistance applied for:

(b)

The need for funds to continue current level of operation. In demonstrating such need the applicant shall take into account:

(c)

The long-term prospect for financial stability.

(d)

The proportion of services provided to high risk and/or medically underserved populations.

(e)

The boundaries of the medical service area currently served by the clinic. Such area shall be designated by census tract.

(f)

A list of services that are supported by the grant. Such presentation shall be in a form that conforms with generally accepted accounting procedures for nonprofit organizations.

(g)

A specific plan of internal evaluation to measure the specific impact the grant will have on the primary health care level of service.