To initiate a request for consultation or technical assistance, please complete and submit the form below. In order to provide high quality, responsive technical assistance, it would be helpful to give as much lead-time as possible. Please enter only one request per form.

Requests will be reviewed by the Center and sent to the NH Bureau of Drug & Alcohol Services for approval before technical assistance is provided. You will receive a response to your request within 10 business days.

Feel free to contact the Center by emailing nhcenterforexcellence@jsi.com or by calling (603) 573-3333 with any questions you may have.

Thank you for your interest in reducing alcohol and other drug misuse and promoting recovery.

 


First Name*

Last Name*

Organization*

Email*

Primary Phone*

City*

State*

PRIMARY AREA OF FOCUS related to your request.*
SBIRTPrevention (Substance Misuse Prevention, Partnership for Success, Student Assistance Programs, Life of an Athlete, Juvenile Diversion)InterventionTreatmentRecovery Support ServicesMedication Assisted TreatmentContinuum of CareDATA & EVALUATION DATA REQUEST: PreventionDATA & EVALUATION DATA REQUEST: TreatmentHub/DoorwayTask ForceOther

Are you currently receiving funding from the NH Bureau of Drug and Alcohol Services?*
YesNo

Are you currently participating in the Regional Network in your area?*
YesNo

REQUEST:*
Please describe the details of your technical assistance request (purpose, background, audience, product needed)

Please provide a date this request is needed by.