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Technical Assistance Request
Complete this brief form to initiate the process of technical assistance.
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Your Name
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Email Address
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Phone Number
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Organization or Agency Name
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Type of Organization
Government
Non-profit
Health Care
Academic
Service Area (Geographic)
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TA Category
Substance use prevention
Substance use diagnosis
Substance use treatment
Substance use recovery
Partnership development
Technical Assistance Request Brief Description
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Desired Outcomes of TA
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Location
Virtual
In-person
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