Health and Human Services Required Information for PCHHS Letters of Support

For more information visit our Health and Human Services site

To allow sufficient time for Pinellas County Health and Human Services’ response as well as clarification of any questions, it is recommended that requests for Letters of Support be submitted at least ten (10) working days in advance of the date a letter is required. Please e-mail a sample support letter for your current project and any letters of support for this proposal previously completed by a county department to humansvs@pinellascounty.org. If your request for a letter of support is granted, the letter of support will be provided to you electronically as a pdf unless otherwise requested. Submission of a letter of support by Pinellas County does not constitute any future commitment of county financial resources to the supported activity or program.

*your e-mail address is required to submit form

E-mail addresses are public records under Florida law and are not exempt from public-records requirements. If you do not want your e-mail address to be subject to being released pursuant to a public-records request, do not send electronic mail to this entity. Instead, contact Pinellas County Utilities by telephone at (727-464-8460) or in writing, via the United States Postal Service at

Pinellas County Health and Human Services
2189 Cleveland St., Suite 201
Clearwater, FL 33765

Applying Agency
Title of Program
Contact Person's Name
Contact Person's Phone
Fax
* Contact Person’s e-Mail Address
Grant Period	Starting date Ending Date
Funding Source	Federal Local Government JWB United Way Foundation Other
Amount of Funding Requested	$
Local Funding Required	No Yes
	If yes, what is the source of Local Funding:
	If multiple funding sources apply, please identify the other participating funders or supporting entities:
Fiscal Agent (if different from applicant agency)
If collaborative delivery of services is anticipated, please identify collaborative agencies involved
Does this proposal directly involve a PCHHS or other county funded program?	No Yes
	If yes, please identify funded program:
Estimated number of impacted	Adults Families Children