California Reducing Disparities Project, Phase 2

Native American Technical Assistance Provider

1. Please enter your contact information

Name:
Organization:
Email Address:
Phone:

2. Please describe any specific needs your organization would like to address with technical assistance and/or training.

3. Optional: Please describe any outcomes you would like to achieve with this TA/training

4. Optional: Approximately how many people will participate in the TA/training?

5. Optional: Please provide any additional information, comments, or concerns you would like us to address about TA in general and/or your specific request.