2019 Underserved Summer Institute Registration

Underserved Grantee Institute

The U.S. Department of Justice Office on Violence Against Women in partnership with the Alliance of Local Service Organizations invites you to participate in the Underserved Grantee Institute. The Institute will take place July 16th - 18th, 2019 in Atlanta, Georgia at the Sheraton Hotel. More information is forthcoming. If you need assistance filling out the registration, please contact us at underservedtaproject@also-chicago.org

This in-person Institute is designed to support the success of your Underserved grant project through facilitation of applied and in-depth learning, dynamic information sharing and action planning. The Institute will be an opportunity for in-person interaction with presenters, facilitators, OVW, and peer grantee organizations, and will focus on the following three main skill building topical areas: 1) data collection and evaluation; 2) training and education; and 3) service provision.

Registration:

Registration closes on Friday, April 26, 2019. Registration is free, however all travel expenses are to be paid from the grant funds obligated to the mandated OVW training portion of your grant award.

This registration form should be completed by ALL individual(s) in your organization/partnership who will be attending the Underserved Grantee Institute. If you need assistance filling out the registration or have questions about the Institute, please contact Program Coordinator Zarena Leblanc at underservedtaproject@also-chicago.org or your ALSO Point of Contact.

Please do not make any hotel or travel arrangements until notified by the ALSO Underserved TA team and/or OVW. More information will be shared after registration closes.

Who Should Attend:

Each grantee is mandated to send 2 people to the Institute. If more than 2 people from your grant team (attendance includes MOU organizations) are interested in attending the Institute, they should fill out a registration; their name(s) will be placed on a waiting list until further information can be provided. Any issues meeting mandatory attendance should be notified to your OVW Program Manager Kara Moller and the ALSO Underserved TA Project.

Please consider sending a combination of (a) significant MOU partner(s), (b) the grant oversight individual and/or (c) the direct front line/implementation individual. Attached to this email you will find the draft agenda for the Institute to help you determine who would benefit most from attending. A final agenda will be posted online and sent to you with your travel letter.

The full 3-day Institute begins Tuesday, July 16th at 8:30 a.m. and concludes Thursday, July 18th, at 4:30 p.m. Please plan on being in attendance for the entirety of the Institute. If you must leave early, you will need to receive advance approval from your OVW Program Manager Kara Moller.

Question Title

* 1. For room booking purposes: please provide anticipated arrival and departure date and time below:

Arrival:

Date

Departure:

Date

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* 2. Contact Information

Prefix:

First Name:

Last Name:

Suffix:

Job Title:

Agency:

Address 1:

Address 2:

City:

State:

Zip:

Phone (xxx.xxx.xxxx):

Extension:

TTY(xxx.xxx.xxxx):

Fax (xxx.xxx.xxxx):

E-mail:

Emergency Contact:

Emergency Number:

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* 3. Which of the following describes your organization regarding the Underserved Grant?

Lead Agency

MOU partner

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* 4. If you are a representative from the MOU partner, please list the Lead Agency on the grant.

Question Title

* 5. Is all of the above information correct? Please note that this information will be used for all meeting materials (i.e. - name badges, table tents, etc.).

Yes

Question Title

* 6. Contact information appears in our meeting materials, including the program. Can we share your contact information with other grant recipients/meeting attendees?

Yes

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* 7. One of ALSO's Technical Assistance (TA) foundations for the Underserved Grant Program is peer to peer learning. Would you be willing to share your program summary with other Underserved grantees at the orientation in order to learn more about the different projects funded under this grant?

Yes

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* 8. Do you have any suggestions for structure or content related to agenda programmatic development? Are there any topics related to your deliverables within the Underserved Program that you would like to see covered (technical assistance around data collection, policies and procedures, outreach methods etc.)? If so, please describe.

We value access and safety and strive to make our meetings accessible and welcoming to all participants. Please fill out the following information to help us provide accommodations that give everyone an opportunity to fully participate in this year's meeting.

Question Title

* 9. Please select any accommodations you require for meeting sessions. In order for services to be as appropriate as possible, please be as specific as possible. Every effort will be made to accommodate requests made in advance. On-site requests cannot be guaranteed.

None required

American Sign Language Interpreter

Close vision/Low vision Interpreter

Cued Speech

Electronic copies of meeting materials in advance

Hard copies of materials on-site

Electronic text file of materials (available at the meeting)

Materials in Braille

Materials in font over 14 pt (please indicate the font size in the "other" box)

Signed English

Certified/ Deaf Interpreter

Assistive Listening Devices

CART

C-PRINT

Simple Language Program

Simultaneous Communication

Wheelchair access

Oral/English

Other (please specify)

Question Title

* 10. Please specify any special hotel accommodations you require. In order for services to be as appropriate as possible, please be as specific as possible. Every effort will be made to accommodate requests made in advance. On-site requests cannot be guaranteed.

ADA Room with Roll-In Shower and double beds

ADA Room with Roll-In Shower and king bed

ADA Room with Tub and Shower and double bed

ADA Room with Tub and Shower and king bed

Chemical Free Room

Room Accessible for Deaf/Hard-of-Hearing with ADA Deaf Kits

Room Preparation for Infant (i.e. - a crib)

None of the above

If necessary, please provide further details describing your preferred accomodations:

If you have a disability that requires a Personal Care Attendant (PCA) or Personal Assistant (PA) to accompany you on your travel, please contact the Underserved TA Project Team at underservedtaproject@also-chicago.org or call 773-235-5705 extension 212 to discuss accommodations.

Every effort will be made to ensure access to this meeting; please allow us sufficient time to meet your request for auxiliary aids and services by submitting your registration by COB April 26th, 2019. Please contact the Underserved TA Project Team at underservedtaproject@also-chicago.org if you need referrals for assistance outside of the meeting and if you have any questions.

Before pressing the “Done” button at the bottom of the registration, please print the page for your records as you will not be able to access the page once you have pressed the “Done” button. The Underserved TA Project page on the ALSO website will be updated to reflect the most current information about this meeting and you will be notified via email about these updates. Please be on the lookout for additional information about the hotel, transportation, meeting agenda and meeting materials. Please do not make any hotel or travel arrangements until notified by the ALSO Underserved TA team and/or OVW.

Thank you for taking the time to complete this registration form!
If you have any questions please contact the Underserved TA Team at
underservedtaproject@also-chicago.org