This is a service contract to provide evaluation for a HRSA-funded Rural Health Outreach Grant awarded to Mariposa Community Health Center to provide patient centered clinical and community services to people with diabetes in Santa Cruz County. The model integrates clinical care, telenutrition classes, peer education classes, and community services.  Evaluation is focusing on improving HbA1C and other health indicators among the patient population with HbA1C of 8.0 or higher.