LGBTQ TA Center Application for Training and Technical Assistance Note to applicants: LGBTQ TA Center Technical Assistance and Training services are only available at this time to organizations that have received grantee funding from the California Reducing Disparities Project, which is funded by the California Department of Public Health, Office of Health Equity. * indicates required field1) Applicant Informationa) Contact InformationFirst Name*Last Name*Title*Organization*Address Line 1*Address Line 2City*State*Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code*County*Phone*Email* Website b) Which CRDP population hub do you work with*Select OneAfrican American (ONTRACK Program Resources)Asian and Pacific Islander (Special Services Group)Latino (University of California, Davis)LGBTQ (Center for Applied Research Solutions)Native American (PIRE)None of the abovec) Please describe the population that you serve and the services you provide.2) Technical Assistance Informationa.) What kind of assistance is needed?(Check all that apply) Customized training Consultation Facilitation Product development Information referral b) Please describe the problem/issue that your organization seeks to address through this technical assistance or training. (Please note if this is a continuation of a previously received TA assignment.)c) What are the specific outcomes to be achieved as a result of receiving technical assistance or training?i)ii)iii)d) Do you have a proposed timeframe for the requested TA?*(Select one)YesNoIf yes, when would it be? For training events, please suggest 2-3 date options.*e) Approximately how many individuals will participate in the TA or training services?*f) What categories of professionals will be attending the training (e.g., administrators, service providers, evaluators, program volunteers, community members, etc.). Provide as much detail as you can.g) Has training on this topic been offered to the proposed participants before?*(Select one)YesNoi) If yes, what were the outcomes?h) Where will TA/training service occur?i) Are you requesting a specific trainer?*(Select one)YesNoi) If yes, please specify:*j) Please provide any additional information that would be useful for us to know regarding your request for TA and/or training services.An important note about evaluation: CARS is committed to ensuring the integrity, relevance and quality of all TA and training services. As a recipient of services, you will be required to participate in evaluation measures. All participants in onsite and webinar trainings will receive an immediate, post-service evaluation form to provide instant feedback. TTA requestors can expect to receive an evaluation survey shortly after services are received to communicate impressions of the TTA, and again 60-90 days post to communicate longer-term impact.