Community Alliance for CLAS Technical Assistance (TA) Request Form

Welcome!

Thank you for your interest in consultation and training from the Community Alliance for Culturally & Linguistically Appropriate Services (CLAS), a project managed by ONTRACK Program Resources, Inc.

Please read the following instructions before completing the application. All organizations, agencies, and institutions working to improve their services to better meet the needs of diverse ethnic and cultural populations are welcome to apply. We recommend that the person answering the questions on the next few pages has been selected to speak on behalf of the organization.

Complete all entries fully and accurately. If you have technical difficulties or trouble with completing the application, please contact Eilene Cary at 916-285-1806 or ecary@ontrackconsulting.org.

We look forward to hearing from you soon!

Applicant information: Please enter complete information (If you DO NOT have email, enter "none"):

First Name *This question is required.

Last Name *This question is required.

Title *This question is required.

Parent Organization/Group Name *This question is required.

Program/Site Name *This question is required.

Program Address *This question is required.

Suite/Bldg/Floor

City *This question is required.

State *This question is required.

Postal Code *This question is required.

County *This question is required. (Please enter local county or counties.)

Email Address *This question is required.

Phone Number *This question is required. Please enter your phone number and any extension, if applicable, as: xxx-xxx-xxxx ext. xxxxx

Fax Number

Website