Information requested from application

Applications must include the following information submitted using the form below. If you have questions about the application, please contact PIAC@CCHAcares.com.

Community Incentive Program Instructions: Click Here to Open / Download
Community Incentive Application Form: Click Here to Open / Download
Community Incentive Application Budget Template: Click Here to Open / Download
Additional Activities to be Funded Form: Click Here to Open / Download

Requested Application Information

If you need the information on this page in another format, please contact CCHA Member Support Services.

The information will be provided in paper form free of charge within 5 business days.

We can connect you to language services or help you find a provider with ADA accommodations.

If you are having a medical or mental health emergency, call 911 or go to your nearest hospital-based ER.

If you are having a mental health or substance use crisis, call Colorado Crisis Services at 1-844-493-8255.