Ujima's Technical Assistance Form

Ujima’s technical assistance (TA) is designed to provide resources, tools, and support to domestic violence coalitions and networks, domestic violence programs, local, state, and federal government agencies, community-based programs, practitioners, researchers; and policymakers regarding family, domestic, and dating violence in the Black community. Ujima’s TA approach is to provide in-depth program assistance and capacity building to improve the design and delivery of programs and services. Ujima offers ongoing technical assistance on-site and virtually via telephone and e-mail.

Please note anything marked * is required. If you are not able to submit the form, please make sure you are entering all required fields.


Ujima's Technical Assistance Form

Ujima’s technical assistance (TA) is designed to provide resources, tools, and support to domestic violence coalitions and networks, domestic violence programs, local, state, and federal government agencies, community-based programs, practitioners, researchers; and policymakers regarding family, domestic, and dating violence in the Black community. Ujima’s TA approach is to provide in-depth program assistance and capacity building to improve the design and delivery of programs and services. Ujima offers ongoing technical assistance on-site and virtually via telephone and e-mail.

Date of Request
Date: *

Information About Person Requesting Assistance
Select which grant this project falls under (select one option only): *
ARP Grantee
OVC Grantee
OVW Grantee
HBCU OVW Grantee
FVPSA Grantee
Unsure
Not Applicable
First Name: *
Last Name: *
Organization/Program Name: *
Position/Title: *
Phone Number: *
Email Address of Person Submitting Form: *
Street Address: *
City: *
State: *
Preferred Method of Contact: *
Email
Phone
Mail
Best Time to Contact: *
Morning
Afternoon
Evening

Information about TA Request
Type of TA Request: *
Funding assistance
Culturally specific training
Agency specific concerns
Capacity building
Phone call or email response to answer specific questions
Development of a program plan, implementation time line, program start up
Program progress and refinements
Evaluation or needs assessment
Other
I’m not sure: Please contact me using the information listed above.
Requested TA: Please provide a detailed description of your technical assistance needs. *
Attach agenda for requested TA session: (Number of files allowed - 0) *




Please note anything marked * is required. If you are not able to submit the form, please make sure you are entering all required fields.