Explore a Partnership with BHODS
Tell us a little about your organization, what you are working through, and the kind of support that may be helpful. We use this information to understand your priorities, determine whether BHODS may be the right partner, and recommend the most useful next step. This form should take approximately 3–5 minutes.
Contact Information
First Name
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Last Name
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Title / Role
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Email Address
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Phone Number
How Did You Hear About Us?
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Google Search
LinkedIn
Referral
Conference/Event
Website
Social Media
Previous Client
Other
Organization Profile
Organization Name
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Organization Type
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Non Profit
For Profit
School
County
Foundation or Philanthropic intermediaries
Schools
State behavioral health agency
Managed Care Plan
FQHC
Trade Assocation
Other Health Facility
Organization Size (Staff)
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1–10
11–50
51–150
151–500
500+
Primary BH & HHS Focus Areas (select all that apply)
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SUD
Mental Health
Co-Occurring Disorders
Crisis Services/988
Housing & Homelessness
Justice-Involved/Reentry
Youth & Family
Maternal & Child Health
Aging & Long-Term Care
IDD
Peer Support
Primary Care/Integrated Health
Other
Funding & RFP History
Current Grant Funding Status
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Yes – active federal
Yes – active state/local
Yes – active foundation/private
Yes – multiple sources
No – new to grant funding
Had grants previously but not currently
Approximate Grant Revenue (Last 12 Months)
$0
Under $250K
$250K–$1M
$1M–$3M
$3M–$10M
$10M+
Funding Sources of Interest (select all that apply)
SAMHSA
HHS/ACF
HRSA
DOJ/BJA
State Medicaid/MCO
State BH/DD Authority
Private Foundations
Corporate/CSR
Not sure yet
Upcoming Opportunity or Deadline Date
Organizational Readiness
Dedicated Grants/Development Staff
Yes – full-time
Yes – part-time or shared
No – leadership handles it
No – looking to build capacity
Data & Reporting Capacity
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Strong (EHR, dashboards, regular reporting)
Moderate (data collected, inconsistent reporting)
Developing
Limited
Current Strategic Plan
Yes – active and current
Yes – needs updating
In development
No strategic plan
Accreditation Status
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CARF
The Joint Commission
COA or other
Pursuing accreditation
Not currently/N/A
How You Track and Communicate Outcomes
Partnership Philosophy & Fit
Decision-Making Role
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Primary decision-maker
Key influencer
Researching on behalf of decision-maker
Other
What else do you want to share with us?
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How would you like an external partner to work with your team?
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Help us understand the issue and recommend a path forward
Lead a defined project in partnership with our team
Add specialized capacity to an existing internal team
Provide ongoing strategic guidance and accountability
We are not sure yet
Anticipated Timeline
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Immediately – active/urgent opportunity
Within 1–3 months
3–6 months
6–12 months
Exploratory – no set timeline
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