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NORTH SOUND ACH 2018 PARTNER APPLICATION: Part 1 <br /> Please provide the following information in the form below.Additional pages can be <br /> used if you need more space. <br /> Organization Name: City of Everett EIN/Tax ID:91-600-1248 _ <br /> Organization Name Listed on W9:City of Everett <br /> Physical Address: 2930 Wetmore Ave., Everett, WA 98201 <br /> Mailing Address,if different: <br /> CEO/ED Name: Mayor Cassie Franklin <br /> CEO/ED Email: cfranklin@everettwa.gov Phone: 425-257-7119 _.- <br /> Application Completed by: — — _. .. -- <br /> Name: Hil Kaman Title: Public Health and Safety Director <br /> Email: hkaman@everettwa.gov Phone: 425-257-8762 <br /> Counties Served by Your Organization:(check all that apply): <br /> LI Island [San Juan EISnohomish EiSkagit uWhatcom <br /> Select sectors that best describes your organization:(You can select more than one) <br /> ©Behavioral Health OPrimary Care ❑Hospital/Health System <br /> O Education 0 Employment ['Emergency Medical Services <br /> ['Food/Nutrition ['Housing 0 Public Health <br /> 0 Social ServicesTransportation 0 Tribal <br /> 0 Other(please identify) Police Embedded Social Workers, High-utilizer coordination (CHART), Mu <br /> Select the best descriptive type for your organization: (you can select more than one) <br /> O Medical Provider(Primary Care,Specialty,Hospital,or Emergency Department) <br /> O Behavioral Health Provider(Substance Use Treatment and Mental Health Treatment) <br /> Tribal Health Clinic <br /> 0 Tribal Behavioral Health <br /> ['✓ Fire &Rescue with EMS <br /> [' Law Enforcement <br /> O Education Organization <br /> O Community Action Agency/Program <br /> O County Public Health, Health or Human Services <br /> d Area Agency on Aging <br /> Other Agencies(not otherwise descrified) Probration; Transit Operator, Human Services Funder <br /> North Sound ACH May 2018 Call for Partners Application 1 <br /> 128 <br />