Back to Partners Toolkit

Returning Partners: Enroll in the Provider Services Network for 2008!

Complete all of the following forms (except the MOU) to enroll in the Provider Services Network.

Please note: If you need to refresh your memory about how to complete these forms, visit our General Instructions page.

• Returning Partner Enrollment Form
  • Exhibit A Service Descriptions
    
    
• W-9 Form
  
  
• DMA Form
  • Terrorist Exclusion List
    
    
• Campaign Contribution Certification Form
             
• Review Copy of the Memorandum of Understanding (MOU)
  • This document is for your review only; you do not need to complete and return it. After your application for enrollment in the Provider Services Network is approved in the Cuyahoga Tapestry System of Care office, you will be asked to sign an MOU that looks like the provided sample.
    
    
• Add/Change/Delete Services Application
  • This form is used by approved agencies only to add, change or to delete from their existing service menu during a PSN MOU year.

If you are having trouble completing your application documents, or you have other questions about this process, Tapestry staff is available to help. Questions about forms, requirements, etc., should go to Carolyn V. Wood at 216-443-5097. Questions about services, descriptions, etc., should go to Karen Ols at
216-443-6127.

Resources Just for Partner Agencies:
Calendar – Glossary of Terms – Publications – Links