This form is for 21st Century Community Learning Center (CCLC) State Education Agency (SEA) Coordinators who wish to request free technical assistance from the U.S. Department of Education's Y4Y TA team. All requests must be received at least eight weeks in advance to allow adequate time for official review and approval. Approval is required before technical assistance can be scheduled and delivered.

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* 1. State or territory:

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* 2. SEA Coordinator/ SEA primary contact name:

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* 3. Email:

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* 4. Phone number:

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* 5. Requested training date(s). Please request 8 weeks in advance.

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* 6. By when do you need to know whether your request is approved?

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* 7. What type of technical assistance event are you requesting?

Note:
On-site technical assistance events must be a minimum of 4 training hours and a maximum of 16 hours. Preference is given to requests that are for in-depth training on a topic for at least a total of 3-4 hours per topic. The team is capable of providing up to 2 days training on topics with at least 2 months notice.

All participants will be expected to create a free Y4Y account as part of the requested technical assistance.

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* 8. For on-site, location:

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* 9. For on-site, please indicate the type of event:

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* 10. Anticipated audience size:

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* 11. Indicate the audience for technical assistance. Select all that apply:

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* 12. Review each technical assistance topic and set of objectives. Select the professional learning topics you would like to request.

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* 13. Would you like to include an overview of Y4Y in your technical assistance event? It is recommended  to include an overview session for on-site events, especially at conferences.

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* 14. How did you determine the Y4Y technical assistance requested meets the professional learning needs of your sub-grantees?

(For example, is this request based on state priority, national priority, evaluation results, needs assessment results, federal suggestion from monitoring and/or technical assistance visit, etc.? Please provide as much detail as possible.)

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* 15. Please attach or upload any files relevant to this request, such as agendas or announcements.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
No file chosen

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* 16. If known, please share any additional information relevant to your request, such as:

-number of participants in each breakout session
-number of desired sessions
-length of sessions

You will receive confirmation of receipt of your request from y4yta@seiservices.com within one business day.

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