TTA Contact Information Form

Attachment 7_TTA Contact Information Form_CLEAN.docx

Training and Technical Assistance (TTA) Program Monitoring

TTA Contact Information Form

OMB: 0930-0389

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Attachment 7: TTA Program Contact Information Form



[Name of Event]

[Date of Event]

[Location of Event]


Because this meeting is federally funded, we have been asked to collect the following information from each participant. All information provided will remain confidential. Please print responses clearly.


Name: _______________________________

Agency Name and Address: _________________________________________

City: __________________________ State: __________ Zip: ____________

Work Phone: ________________ Work E-mail address: _______________________


Are you willing to be contacted for a brief, Yes

two-month follow-up evaluation of this event? No


If yes, what is your preferred method of contact? E-mail

Mail


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleExploring Workforce Issues in the
AuthorJennifer Ellingwood
File Modified0000-00-00
File Created2022-04-07

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