a) Applications shall be submitted to the Department at the following address:

Regional Ambulance Services Grant Project

Illinois Department of Public Health

Division of Emergency Medical Services

525 W. Jefferson St., 3^rd Floor

Springfield, Illinois 62761

b) Applications shall include the following:

1. 1) The officer or agency designated by the regional ambulance service to be responsible for administering grant funds;
2. 2) The results of the needs assessment conducted pursuant to Section 547.400;
3. 3) The organization and responsibilities of the Board;
4. 4) The operations budget of the regional ambulance service, including projections on how and when the regional ambulance service will become self-sufficient, and a description of local financial support or in-kind service;
5. 5) A staffing plan for the regional ambulance service;
6. 6) An agreement by the applicant to ensure that the requirements of the Emergency Medical Services Systems Act will be met;
7. 7) A description of the proposed interaction between any existing ambulance services and the regional ambulance service;
8. 8) A description of the support of the local medical communities for the regional ambulance service;

9. 9) A plan for quality management, including an evaluation of the project to be submitted to the Department after the first six months of operation, that indicates:

   1. A) the amount of grant funds expended and a description of expenditures;
   2. B) changes that have occurred in service provided as a result of the grant project; and
   3. C) an evaluation of the effectiveness of the officer or agency designated by the regional ambulance service to be responsible for administering grant funds;
10. 10) A description of a plan for the provision of education for ambulance service personnel and a plan for public education by the regional ambulance service;
11. 11) A description of the responsibilities of service providers, including maintenance of vehicles and equipment;
12. 12) A description of the communications system that will be used by the regional ambulance service; and
13. 13) The name, address, and telephone number of the person to whom questions and information concerning the application and the grant project are to be directed.