Name of Healthcare Facility ReceivingRequesting Funding Street Address City State Zip Code Date Signature of Authorized Official Please mail form to U - PDF document

Name of Healthcare Facility ReceivingRequesting Funding Street Address City State Zip Code Date Signature of Authorized Official Please mail form to U
Name of Healthcare Facility ReceivingRequesting Funding Street Address City State Zip Code Date Signature of Authorized Official Please mail form to U

Name of Healthcare Facility ReceivingRequesting Funding Street Address City State Zip Code Date Signature of Authorized Official Please mail form to U - Description


S Department of Health Human Services Office for Civil Rights 200 Independence Ave SW Washington DC 20201 Name and Title of Authorized Official please print or type ASSURANCE OF COMPLIANCE ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS AC ID: 36738 Download Pdf

Tags

Department Health

Embed / Share - Name of Healthcare Facility ReceivingRequesting Funding Street Address City State Zip Code Date Signature of Authorized Official Please mail form to U


Presentation on theme: "Name of Healthcare Facility ReceivingRequesting Funding Street Address City State Zip Code Date Signature of Authorized Official Please mail form to U"— Presentation transcript


Shom More....
tatyana-admore
By: tatyana-admore
Views: 117
Type: Public

Download Section

Please download the presentation from below link :


Download Pdf - The PPT/PDF document "Name of Healthcare Facility ReceivingReq..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.

Try DocSlides online tool for compressing your PDF Files Try Now