AppCoverPage.docx

This is an Application Cover Page for the Virginia Rural Health Training Program (RHTP) subrecipient award, specifically for the "Connected to Care, Closer to Home: Innovative Maternal Care" initiative administered by the state of Virginia. The form serves as the required first page of a completed application package and must be submitted following the designated submission method outlined in the Request for Applications (RFA). Applicants are required to provide comprehensive organizational information including the project title, total funding requested, legal organization name, organization type (state agency, local government, tribal entity, nonprofit 501(c)(3), for-profit entity, institution of higher education, hospital/health system, or other), year established, number of employees, organization website, Federal Tax ID (EIN), and Unique Entity Identifier (UEI). The form also requires confirmation of active SAM.gov registration and complete mailing address information.

The Authorized Organizational Representative (AOR) must certify that all application information is true, accurate, and complete, and that the organization accepts all conditions of a Virginia RHTP subrecipient award and will comply with 2 CFR Part 200, CMS RHTP Program Terms and Conditions, and all applicable federal and state requirements. The AOR certification requires the full name, title, email, direct phone number, date, and signature of the authorized representative. This cover page does not specify funding amounts, pricing terms, award dates, or contract term details, as those elements would be addressed in the accompanying RFA documentation and subsequent award notifications.