Please complete the technical assistance form, providing as much detail as possible on the work you are doing and the support you seek.

First Name*

Last Name*

Organization*

Email*

Primary Phone*

City*

State*

PRIMARY AREA OF FOCUS related to your request.*
Screening, Brief Intervention, and Referral to TreatmentPrevention (Substance Misuse Prevention, Partnership for Success, Student Assistance Programs, Life of an Athlete, Young Adult Strategies, Juvenile Diversion)InterventionTreatmentRecovery Support ServicesMedication Assisted TreatmentContinuum of CareDATA & EVALUATION DATA REQUEST: PreventionDATA & EVALUATION DATA REQUEST: TreatmentNH DoorwayNH Governor's Commission on Alcohol and Other Drugs/Task ForcesOther

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

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

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

Please provide a date this request is needed by. Provide a due date that includes at least ten business days to review the request along with additional time to complete the request.

 

You will receive a response to your request within ten (10) business days from when you submit.