Request TA/Training Application Form

For SDFSC Grantees funded by the Governor's Program

Please complete application 4 weeks prior to proposed training/TA

* denotes required field

A. APPLICANT INFORMATION

First Name*
Last Name*
Title*
Organization*
Address Line 1*
Address Line 2*
City*
State*   Zip Code
County*
Phone*( )   -  Ext:
Fax( )   -
Other( )   -
Email*
Website

B. TECHNICAL ASSISTANCE INFORMATION

What kind of assistance is needed? (Check all that apply)*
Workshop-By-Request
Other Training
Consultation
Other
If requesting to Host a Workshop-By-Request, please specify which:
Please Describe:*
Please identify the primary goal(s) to be achieved through the requested technical assistance or training.
Outcome #1*
Outcome #2
Outcome #3
Which of the following is your preferred format to receive technical assistance/training?*
On-Site
Other Off-Site Location
Conference Call
Other
Proposed Training Date(s):*
Estimated # of Participants:*
Would you like to request a specific consultant or consultants?*
Yes     No    
If yes, please specify:

Please click the Submit button to complete your application. A staff person will contact you in a few days to discuss your request.
Request Technical Assistance Training
ph 707-568-3800  fx 707-568-3810

The SDFSC TA Project is funded by the California Department of Alcohol and Drug Programs (ADP) and managed by the Center for Applied Research Solutions (CARS).
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