1. Insert SHC/Sponsoring Agency Name and Logo

2. Mission  Insert sponsoring agency mission statement SHC mission statement/goals/values ………………

3. Background History Insert a brief blurb about the history of your agency’s SHCs: How did they come about? Who were the key partners? What was the community response? Other notable early experiences?

4. Community Partners We partner with:  Insert list of partners We receive funding from:  Illinois Department of Public Health  …

5. Program Overview Insert a brief blurb about your program goals and model. What are you focused on achieving? What are your core programs? How do you staff your sites?

6. Demographics Grades/Ages Served: Insert grades or ages served Census Information : Insert racial demographics % of Medicaid Eligibility : Insert Medicaid eligibility rate English Proficiency Rates : Insert English proficiency rates / languages spoken Free/Reduced School Lunch Program participants : Insert rate of participation in free/reduced school lunch program

7. Locations Insert site list with contact information for each and photos if available

8. Services Provided  Insert list of all services provided (i.e. medical, behavioral health, nutrition, health education, etc.)

9. Patient Consent and Eligibility  Briefly describe your processes for obtaining patient consent and verifying eligibility.

10. Staff  Insert list of your staff and photos if available

11. Encounter Data Insert list of encounter data you currently track

12. Noted Accomplishments  Insert list of accomplishments and awards (e.g. from your agency, from external partners, from school, from accrediting bodies, from government entities, or foundations).

13. Clinical Accomplishments  Insert list of major accomplishments you’ve identified through clinical data monitoring (i.e. chronic disease management, immunizations, well-child visits, risk assessments, etc.)

14. Clinical Accomplishments  Insert tables or graphs to illustrate the previous list

15. The Future  Moving forward, what are you hoping to accomplish.

16. Insert logo and key contact information