funded under contract by the Office of Safe and Drug-Free Schools
Technical assistance will be administered by EMT. If you have questions about this application, please contact: Kari Heard at kari@emt.org or (877) 579-4788. Thank you!
Select Lead Grantee Organization:
Program Name:
Organization Requesting TA: (if different than above)
First name: Last name: Title:
Address:
City: State: Zip:
Phone: Fax:
E-mail: Website:
1. How did you hear about mentoring program technical assistance?
Colleague Department of Education ED Mentoring Website Listserv Mentoring consultant MRC/EMT/NMC staff National OSDFS Conference Previous utilization Regional Training Other:
2. Please, describe your consultation or technical assistance needs
3. What do you hope to achieve as a result of the technical assistance?
4. Preferred method(s) of consultation delivery (Check all that apply)
Group consultation with a lead consultant and other grantees that have similar needs Materials Online consultation Onsite consultation Phone consultation Regional consultation/training
5. Proposed dates of requested training:
6. Estimated number of participants:
7. Are you willing/able to travel to attend the consultation training at a local host site?
Yes No
8. Other comments:
mentoring resource center | contact & tech support | disclaimer of endorsement
