CHI Forms
Applicants subject to CHI requirement are expected to contact the Department at DONCHI@State.MA.US at least two months prior to the planned filing of the DoN Application in order to determine which forms will be required at the time of Application.
Downloading the Forms
The interactive PDFs listed under Additional Resources are not supported by most browsers (e.g. Google Chrome or Safari). To access, users may need to right-click the PDF link, and select "save as (pdf)" to save the file to their local drive/folder, and open the downloaded PDF file in Adobe Reader. This method keeps the form in an interactive format, meaning responses can be inputted directly into the PDF. Note: this means users must have access to Adobe Reader or any PDF-viewing app on their device first.
If additional assistance is needed to access the forms, please email DONCHI@State.MA.US.
Partner Assessment
This assessment is designed to elicit objective feedback on the levels of Community Engagement throughout the CHNA/CHIP process from the perspective of community partners. Visit the online Community Engagement Partner Assessment.
Additional Resources
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Open PDF file, 1.32 MB, CHNA/CHIP Self-Assessment (English, PDF 1.32 MB)
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Open PDF file, 779.1 KB, Community Engagement Plan (English, PDF 779.1 KB)
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Open PDF file, 458.08 KB, Community Engagement Guidelines for Community Health Planning - PDF (English, PDF 458.08 KB)
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Open DOCX file, 868.97 KB, Community Engagement Guidelines for Community Health Planning - MS Word Doc (English, DOCX 868.97 KB)
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Open PDF file, 382.12 KB, Community Health Initiative Planning (English, PDF 382.12 KB)
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Open DOCX file, 1.07 MB, Community Health Initiative Planning (English, DOCX 1.07 MB)
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Open PDF file, 786.78 KB, Health Priority (English, PDF 786.78 KB)
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Open DOCX file, 1.12 MB, Health Priority (English, DOCX 1.12 MB)