CTAS Area 4 Training and Technical Assistance Request Form

CTAS Area 4 T/TA Request Form (Ver. 3.9.12)

Congratulations on your CTAS Area 4 grant award! The National Indian Justice Center (NIJC) and EKM&P Associates will serve as your training and technical assistance (T/TA) providers during your project period. To initiate a request for T/TA, please complete this form online, send us an e-mail, fax us or call.

Send requests via e-mail to nijc@aol.com or call Kelly at (707) 579-5507. You can fax the printed form or written request to fax# (707) 579-9019. You may also submit your T/TA requests online at:
https://www.surveymonkey.com/s/TTATracking

Question Title

* 1. Date Submitted:

Date that this T/TA Request Form was completed and submitted:

Date

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* 2. Please provide the following contact information:

Name:

Tribe or Organization:

Title:

Address:

City:

State:

Zip:

Email Address:

Phone Number:

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* 3. If you have a resource request and/or require an item to be faxed, please provide your fax number:

Fax Number:

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* 4. Please provide a deadline date if your request is time sensitive:

Info required by:

Date