Training and Technical Assistance Request Form

Use this form to request training and technical assistance from the National Gang Center. Assistance includes recommending conference speakers, assessing your community’s gang problem, implementing the OJJDP Comprehensive Gang Model, training for street gang investigators and gang unit supervisors, and developing youth gang intervention, prevention, and suppression strategies.

All fields, except for “fax,” are required.

SECTION I—Requestor Information

Requesting Agency/Organization:

Requestor’s Name:

Requestor’s Title:

Address:

Phone:

Fax (not required):

E-Mail Address:

Date(s) TA Is Needed:

SECTION II—Type of TA Request

Indicate Type of Request: Speaker
Training
Technical Assistance
Other (please explain):

SECTION III—Description of TA Request

Provide concise and complete information in each section below.

Problem Statement: Describe, as specifically as possible, the condition or issue for which the training or technical assistance is requested.
Previous Efforts: Have there been any previous attempts to address the condition or issue for which the training or technical assistance is requested? If so, what action(s) were taken and what were the results?
Training or Technical Assistance: Describe what type of training or technical assistance you would like to receive.
Target Audience/Recipients: List the intended audience or recipients of the training or technical assistance.
Goals and Outcomes: Describe the goals and outcomes you would like to achieve as a result of this training or technical assistance. Include how this will assist you in achieving the goals of specific purpose areas indicated above.
Resources/Consultants: Are there any specific resources you need or consultants from whom you would like to receive training or technical assistance? If so, please describe these resources and provide consultant/provider contact information. If not, please describe the specific areas of expertise that would be helpful.