Alliance for Better Health Transformation Fund Application

1. Organization name *This question is required.

2. Name of organizational contact *This question is required.

3. Email address *This question is required. This question requires a valid email address.

4. Phone number *This question is required. This question requires a valid number format.

For questions 5 and 6, please select those performance measures in which your organization has chosen to participate. This commitment continues through the measurement year ending 6/30/2018, and is required for eligibility for Transformation Fund distributions based upon Department of Health (DOH) performance determinations and related payments to Alliance in January and July of 2018.