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If you are an organization or professional, please fill this form out to help us understand how we can assist you with CtLC.
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Questions marked with * are required for form submission.
What best describes your need?
I am requesting information for:
Organizational Training
Organizational Technical Assistance
Becoming a LifeCourse Partner or Chapter
Information on LifeCourse Tools, Templates
Professional Training for Myself
Help with registration for an upcoming training
Other Need
About You
First Name
Last Name
Preferred Contact Number
Email
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington, DC
Do you have a time sensitive or urgent need?
Yes
No
If you have a time-sensitive need - what is your timeframe?
Within 30 days or less
Within 3 months
Within 6 months
Within 12 months
How familiar are you/your organization with the CtLC Framework?
I have no or limited knowledge about CtLC
I know general information about CtLC but do not use it yet
I know different ways that I can use CtLC but I have not started using it regularly
I use CtLC regularly but need some guidance to use
I use CtLC regularly without much effort or stress
I use CtLC regularly and adapt it to different situations
Training for my Organization
What is the name of your organization?
What is the primary focus of your organization?
Developmental Disability
Aging and Disability
Behavioral Health
Employment
Traumatic Brain Injury
Direct Service Provision
Early Childhood
General Education
Special Education/Transition
Post-Secondary Education
Self-Advocate/Family Network
Other (please list below)
What is your organization's primary function?
Government Agency
Direct Service Provider
Case Management
Front Door to Services
Educational Organization
Other (please list below)
What kind of organizational training are you interested in?
Ambassador Series
Badge Academy
Skill Building Series
Please provide any additional information about your organization's training needs.
Technical Assistance for an Organization
What is the name of your organization?
What is the primary focus of your organization?
Developmental Disability
Aging and Disability
Behavioral Health
Employment
Traumatic Brain Injury
Direct Service Provision
Early Childhood
General Education
Special Education/Transition
Post-Secondary Education
Self-Advocate/Family Network
Other (please list below)
What is your organization's primary function?
Government Agency
Direct Service Provider
Case Management
Front Door to Services
Educational Organization
Other (please list below)
What are your organizational goal(s) for using CtLC?
Use tools, resources and/or products/materials
Develop or adapt tools, resources and/or products/materials
Organizational alignment to support my organization in integrating CtLC into practice, policy and procedure.
Strategic Thinking through the lens of the framework, principle and tools
Customized Training for My Organization
Additional Information - Please provide a few sentences explaining what you are looking for / inquiring about / would like more information:
Professional Training
What kind of training are you interested in?
Ambassador Series
Skill Building Series
Badge Academy
Please provide any additional information that would help us with your professional training needs.
Registration Issue
What training are you interested in registering for?
How can we assist you?
Other Need
Please let us know what you are looking for from the LifeCourse:
Having someone from the LifeCourse come to a conference or event
Information on training for myself
Information about trainings on the LifeCouse website
Information about using the tools and other materials on the LifeCourse website
How to become a LifeCourse trainer
Please provide a few sentences explaining what you are looking for/inquiring about/would like more information on
Please provide some information on the type and purpose of the event you would like to have someone from the LifeCourse attend.
LifeCourse Partner or Chapter
Please provide some information about your goals in joining the LifeCourse Network:
What is the name of your organization?
Click here for additional information about partnership with the LifeCourse
Click here for more information about becoming a LifeCourse Chapter
LifeCourse Tools or Templates
What are you interested in?
Can I use the Tools, Videos and other materials from your website?
Can I make changes to the tools on your website?
Other
Please provide additional information about your needs:
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Contact Information