Organization Requirements

Organizations submitting an application must meet the following criteria:

• Organization must be able to provide a 501(c)3 Determination Letter
• Organization must answer each application question completely. 
  • Do not include any materials not requested with your application, or any private personal identifiable information that would constitute special handling or breach of confidentiality.
• For Polk County resident(s) following a one-time service/program, the organization must ensure the reoccurring proposed service/program will be for:
  • Gross family/household income at or below 200% of the Federal Poverty Level Guidelines.
  • Documented full-time resident of Polk County (See Proof of Residency Guidelines)
  • Have no other health insurance or the availability of health coverage, including Medicaid, Medicare, Polk Healthcare Plan, Veteran’s Health Benefits, or any private insurance.
• Organization understands there will be mandatory data collection of eligibility determination and monthly reporting requirements.
• Organization understands record retention (digital acceptable) is required for a ten (10) year period.
• Organization agrees to submit application in required format. Applications that do not follow the required format may lose points.
  • Late proposals will not be accepted or reviewed for funding consideration.
• Organization has reviewed the Florida Statutes 212.005(7) and Polk County Ordinance 2015-76, as amended.