Technology Assistance Program - Signup Form
Thank you for your interest in our Technology Assistance Program (TAP)! To be notified about future TAP programs, please fill out the brief survey below:
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1.
First Name:
(Required.)
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2.
Last Name:
(Required.)
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3.
Email Address:
(Required.)
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4.
Phone Number:
(Required.)
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5.
City:
(Required.)
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6.
State/territory:
(Required.)
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia (DC)
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
U.S. Virgin Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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7.
How do you prefer to be notified about future TAP programs?
(Required.)
Phone
Email
No preference
Questions, concerns, or need any additional assistance?
Contact Nicole Jarvis, LMSW, Assistance Director of Programs, at njarvis@cew.org or 646-929-8043.