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Pilot Program

  • The Star Rating System Application for Program Pilot

  • Organization Contact

  • Organization Demographics

  • Assigned Staff for Program Pilot

    Please list the organization’s staff members who will be assigned to the pilot program. Staff must be able to commit for the 12-month pilot period.
  • Organization's Responsible Committee & Membership Information

  • Please list below the organization’s cultural competence committee members who will be assigned to the pilot program. Committee members must be able to commit for the 12-month pilot period. If a committee member is listed above it is not necessary to relist the information in this section. Please list the name of the organization’s cultural competence committee:
  • Expression of Interest

  • 1. Describe the organization’s current cultural competency (diversity, equity, inclusion, and accessibility) advisory structure.
  • 2. Please list any potential barriers to implementation and/or completion of the program that may exist. How does the organization plan to account for and/or resolve these barriers to ensure successful participation in the pilot program?
  • 3. Please explain how the organization will begin to adopt changes or improvements within months following completion of the pilot program.
  • 4. Describe the impact on the organization’s mental health programs services if selected to participate in this pilot program.