T/TA Request

Please use this form to submit a training or technical assistance (T/TA) request to the Southeast Prevention Technology Transfer Center (PTTC). Provide answers to as many questions as possible so we can provide you with the best service.

We look forward to assisting you!

Your first and last name:

Your title/role:

Your organization:

Your email:

Your phone number:

In which state are you working?

For what county/counties is this TA request?

If it serves the entire state, please write "statewide".

You selected other. Please specify the state in which you work:

Have you submitted a T/TA request to the Southeast PTTC before (either via email, phone or here)?

Yes

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How did you hear about the Southeast Prevention Technology Transfer Center's TA services?

Yes there a specific date or deadline for this request?

Yes, there is a specific date/deadline (please specify below)

No, we are flexible

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Please use this space to add any additional information about the T/TA request deadline:

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Please describe in as much detail as possible what type of support you are requesting and what you hope to achieve:

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Please describe the audience or recipients of this request (i.e. prevention professionals, providers, coalition members, etc.):

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Please use this space to provide any additional information about the T/TA request:

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About You

About the T/TA Needs

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