Exhibit A_Application Cover Page (2).pdf

This document is an application cover page for the Virginia Rural Health Transformation Program (RHTP) Earn to Learn Initiative, administered by Virginia Works in conjunction with the Virginia Department of Medical Assistance Services (DMAS). The RFA seeks applications from eligible organizations to support rural healthcare workforce development throughout Virginia. Applicants must submit a completed application package with this cover page as the first document, following the submission method specified in the RFA cover page. The application requires applicants to provide project titles, total funding requests, organizational information, and an executive summary describing program needs and design.

Applicants must be authorized organizational representatives who certify under penalty of perjury that all submitted information is accurate and complete, and that their organization will comply with 2 CFR Part 200, CMS RHTP Program Terms and Conditions, and all applicable federal and state requirements. Eligible organization types include state agencies, local governments, tribal entities, nonprofits with 501(c)(3) status, for-profit entities, institutions of higher education, hospital and health systems, and other specified entities. The application requires standard organizational documentation including legal name, EIN, Unique Entity Identifier (UEI), SAM.gov registration status, mailing address, number of employees, year established, and organization website. Applicants must include the full name, title, email, and direct phone number of the authorized organizational representative who will sign the certification.