Request Training or Technical Assistance (BACKUP) TA Request Form The purpose of training and technical assistance (TTA) is to build CCC system capacity. In order to achieve this goal, a broad array of consultation or coaching, training, sponsorship, or other development services may be available to colleges. First Name* Last Name* Title* Organization* Address Line 1* Address Line 2 City* Zip Code* Phone*Email* 1. What kind of assistance are you requesting (check all that apply): Customized Training or Technical Assistance Logistical support for planning your own meeting or event Each Mind Matters or Crisis Text Line Materials Product development Training, workshop series (e.g., LGBTQ, Trauma Informed Care, SBIRT, HIPAA/FERPA) Travel support to present at/attend a training event or conference Other 2. Please describe your request for assistance and include topic(s) of focus:*3. If you have a proposed timeline for the requested assistance, please describe: 4. Please identify the geographic area(s) for marketing the event or service. Campus District Regional Statewide County/Local 5. Does your organization have resources to pay for or share the cost of the technical assistance or training services?* Yes No If yes, please describe: 6. Please provide any other information that would be useful for us to know regarding your request for assistance and/or training services:*