Fillable Printable Letter of Interest to Apply
Fillable Printable Letter of Interest to Apply
Letter of Interest to Apply
Attachment #4
Sample Letter of Commitment from Board of Directors or Equivalent
Official
New York State Department of Health AIDS Institute
Corning Tower
Empire State Plaza
Albany, NY 12237
Dear :
The Board of Directors (or Equivalent Official) of (Applicant Organization) has reviewed and
approved the enclosed application to the New York State Department of Health AIDS Institute for
funding under the solicitation “Community-Based HIV Primary Care and Prevention Services.”
The Board (or Equivalent Official) is committed to providing the related services and certifies that
program staff are qualified, appropriately trained and have sufficient agency resources to effectively
implement the program.
The Board (or Equivalent Official) attests as an applicant under Components A, B or C , the
organization is one of the following eligible organizations:
q Licensed by the New York State Department of Health under Article 28 of the Public
Health Law.
q Not-for-profit 501c(3) health care organization or a county health department.
q Provide HIV primary care services as part of the organization’s scope of services.
In addition, as an applicant for Component A, the Board attests that the organization:
q Proposes providing continuous HIV primary care services to a minimum of 90 HIV-
positive patients.
In addition, as an applicant for Component B, the Board attests that the organization:
q Meets the requirement that at least 80% of the patients receiving continuous medical care
are HIV-positive.
q Is located outside of New York City, Long Island, and Lower Hudson.
In addition, as an applicant for Component C, the Board attests that the organization:
q Is located in NYC in the borough of the Bronx or in Upper Manhattan (95
th
Street and
above).
Sincerely,
Chairperson/President
Board of Directors
