If your agency would like to become a vendor agency in High Fidelity Wraparound Erie County, below you will find an example of some of the things you will need to provide as part of your application:

• List of Proposed HFW Service Codes – The services you would like to provide for High Fidelity Wraparound Erie County
• List of Current and Past Licenses, Contracts, Approved Programs, and Certifications
• Statement Describing Other Agency Affiliations Demonstrating Interagency Cooperative Ventures
• Statement Detailing Your Agency’s Ability to Serve Youth in Erie County Children’s System of Care
• Agency Mission and Vision
• History of the Agency
• Populations Currently Served by the Agency
• Agency Governing Body/Board of Directors
• Agency Organizational Chart – Specifically detailing how your vendor program will operate and be supervised
• Supervision Policy
• Corporate Compliance Policy
• Confidentiality and HIPAA Policies
• Cultural and Linguistic Competency Policy
• Risk Management Policy – Including incident reporting and grievance procedures
• Quality Assurance & Quality Improvement Policies
• New Hire Policy – Including training requirements
• Proof of Ability to Provide State Central Registry and NYS Justice Center Background Checks
• Agency Proof of Insurance Coverage
• Agency Proof of Status to do Business in NYS
• 3 Letters of Recommendation – At least one must be from a current member of High Fidelity Wraparound Erie County Children’s System of Care

Vendor Agency Application
Sample Contract