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* 1. Organization Name:

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* 2. Point of Contact:

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* 3. Email Address:

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* 4. Phone Number:

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* 5. Please enter your Residential Child Care License Number:

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* 6. Is your organization's RCCL in good standing? (Not on probation or at risk of revocation)

If your organization is on Heightened Monitoring but not on probation or at risk of revocation, check yes.

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* 7. Please list any accreditations your organization has:

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* 8. Does your organization contract with either DFPS or a Single Source Continuum Contractor? (Note: If your organization is the SSCC for your region, check yes.)

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* 9. Please describe your organization: history, programs/services offered, the structure of your leadership team, annual budget, and any relevant background for the organization’s leadership (500 words or fewer).

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* 10. How does your organization demonstrate a commitment to equitable practices, including how you address issues associated with diversity, inclusion, and disproportionality? (500 words or fewer)

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* 11. What are the biggest indicators that your organization needs access to this opportunity? (800 words or fewer).

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* 12. Identify which leaders within your organization will be responsible for engaging in the proposed work (350 words or fewer).

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* 13. How do you see this project promoting the success of your organization and contributing to the growth of quality capacity of CSEY services? (350 words or fewer)

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* 14. Please rank the following trainings in order of preference for your organization's needs:

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* 15. Please choose your top two (2) areas of TA needs:

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* 16. Please tell us a bit more about why you selected these two as priorities, including one change that you hope to see happen within your organization as a result of this TA (500 words or fewer).

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* 17. Is your organization interested in participating in the TBRI Peer-to-Peer Learning Collaborative?

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* 18. I affirm that the answers I have provided are true to the best of my knowledge.

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