Request for Assistance

Please fill out the form below in order to request PREA-related training and/or technical assistance for your jurisdiction or agency. The more detail provided in your request will improve the PRC's ability to meet your needs. For jurisdictions less familiarity on PREA, the PRC would encourage you browse the resources in the "PREA 101" page first. If your jurisdiction has general questions or comments for the PRC you can communicate those through our "Contact Us" page.

Name of jurisdiction/agency making request: *

Name and position/title of person making request: *

Contact Information of Requester

Address:

City/Town:

State:

ZIP:

Email: *

Phone: *

Point of contact for the jurisdiction/agency:

Statement of Problem:

Describe, as specifically as possible, the condition or issue for which the TTA is requested.

Previous Efforts:

Have there been any previous attempts to address the condition or issue for which the TTA is requested? If so, what action(s) were taken and what were the results?

Training and Technical Assistance:

Describe what type of training or technical assistance you would like to receive.

Targeted 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.

Resource/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.

Other Comments:

Are there any other important details you would like us to know when considering your request?

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