CDMCF TTA Request Form
Please use this form to request training and technical assistance associated with the COVID-19 Detection and Mitigation in Confinement Facilities grant. TTA will be provided by an SME.
ELC Recipient Jurisdiction
*
AK
AL
AR
AS
AZ
CA
CHI
CO
CT
DC
DE
FL
FM
GA
GU
HI
HOU
IA
ID
IL
IN
KS
KY
LA
LAC
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
NYC
OH
OK
OR
PA
PHL
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
N/A
Date Request Submitted
Requestor Name
*
Requestor's Email
*
ELC Subrecipient
(Optional)
Agency Requesting TTA
*
Summary of Request
*
Please include request details, desired timeframe, and any questions/concerns.
Goals/Objectives
For Peer to Peer TTA, Onsite Assistance, and SME Consultations, please describe the overall goals and objectives of the specified TTA.
File Attachments
(Optional)
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Email address
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