NACTF T/IT Resource Request Form-Round 2

Purpose

The Native American Children Training Forum (NACTF) is a project of the National Indian Justice Center (NIJC) that seeks to assess and improve the telecommunications/ information technology (T/IT) and training capacity of Tribes and organizations that provide services to Native American Children who have been abused and/or neglected, or at risk.

As part of a grant from CalEMA, the NACTF has some resources to improve technology at the local level. At least five (5) service providers will be provided with telecommunication/information technology equipment conducive to on-site training. Tribes providing services to Native American Children who have been abused and/or neglected, or at risk are eligible to apply as well. The service providers receiving these resources will be chosen from our priority list. To be placed on our priority listing Tribes/service providers must meet the following eligibility:

1. Completion of our Needs Assessment Survey. If you have not completed the Needs Assessment Survey, please do so at: https://www.surveymonkey.com/s/NACTFTechAssessment

2. Completion and submission of this Resource Request Form. https://www.surveymonkey.com/s/NACTF_Tech_Request

REQUEST FORMS MUST BE RECEIVED BY April 30, 2013

Background

NIJC conducted a needs assessment of service providers serving abused and/or neglected or at risk Native American Children in Summer/Fall of 2012. We are currently accepting requests for resources during this next phase of that project. Because you/your service provider participated in our needs assessment or you were identified as a service provider by our Expert Panel, NIJC invites you to submit a proposal to receive T/IT resources as part of this project.

Eligibility Criteria for Resources

To receive T/IT resources through this project service providers must:

1. Complete our Needs Assessment Survey. If you have not completed the Needs Assessment Survey, please do so prior to submitting your request form at: https://www.surveymonkey.com/s/NACTFTechAssessment

2. Approval to participate in our program by your governing authority (Tribal Council, Board, etc.)

3. Complete and submit this Resource Request Form (DEADLINE is April 30, 2013). https://www.surveymonkey.com/s/NACTF_Round2

PLEASE CONFIRM THE WILLINGNESS OF YOUR GOVERNING AUTHORITY TO PARTICIPATE IN THIS PROJECT BEFORE COMPLETING THIS REQUEST FORM.

Once we have received this request form and verified completion of the needs assessment survey, your request will be submitted to our Expert Panel for review. Service providers will be chosen based on statewide community needs and the needs of the project. If chosen to receive resources, we will coordinate with you and your IT liaison. Once identified to receive resources you will be required to enter into an MOU with NIJC regarding receipt of the IT resources, which includes a commitment to participate in this project. For more information about this project and a template of the MOU: http://www.nijc.org/NACTF.html.


Submission of Request Form

You may submit your T/IT requests online at:
https://www.surveymonkey.com/s/NACTF_Round2

If you can't complete the survey online, you may also submit your completed surveys by saving and printing your survey responses in a pdf (please verify that your responses are saved), and sending by mail, email or fax to: National Indian Justice, Attn: Native American Children Training Forum, 5250 Aero Drive, Santa Rosa, CA 95403 Attn: Stephanie Lucero, Program Specialist: (707) 579-5507, Fax: (707) 579-9019, Email: stephanie@nijc.org.

For questions or assistance completing this form contact Stephanie Lucero at stephanie@nijc.org

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* 1. Date Submitted:

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* 2. Please provide the following information for Applicant:

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* 3. Please indicate tribal or organizational status:

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* 4. Please provide information for the Contact Person for this Application:

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* 5. If you require an item to be faxed, please provide your fax number:

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