Bring the HEAL Trafficking Technical Assistance Consultancy Team to Strengthen Your Health Care Anti-Trafficking Work

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Please fill out this form as accurately and comprehensively as possible. Depending on the current structure of your health system/organization, some questions may not be fully applicable. Do your best to paint a clear picture of your current status and technical assistance needs.

Please note that HEAL is unable to take on pro bono consultancy projects at this time.

Email *

Organization *

Name of organization point of contact *

Phone number of organization point of contact *

How did you learn about HEAL Trafficking? *

Search engine (Google, Yahoo, etc.)

Recommended by a colleague

Social media

Academic publication

Other:

Do you participate on any HEAL online forum? Please check all that apply: *

Human Trafficking and Health Care - HEAL Trafficking

HEAL Trafficking Research

HEAL Trafficking Education and Training

HEAL Trafficking Direct Service

HEAL Trafficking Advocacy

HEAL Trafficking Protocols

None

Required

HEAL Trafficking provides a variety of technical assistance services. Please select your desired service(s) from the list below. *

Custom Protocol Development

Human Trafficking Curriculum Consultation/Customized Training

Other custom consultation

Other:

Required

Please select whichever description best describes your organization. *

Advocacy organization

Behavioral health and/or substance use provider

Child welfare and/or runaway and homeless youth service

Federal, state, local, city, and/or tribal government agency

Human trafficking taskforce

Hospital association

Law enforcement

Medical service provider/health system

Private, not-for-profit (including faith- and community-based organizations), direct services provider

Public health service

Research organizations

School-based health provider

Violence prevention agency

Volunteer service center providing support to trafficking survivors or populations at risk of human trafficking

Other:

Please use this section to provide as much detail as possible about your consultancy needs, INCLUDING: the general size of your organization/health system, your demographics served, and your goals for a potential HEAL consultancy. *

If you selected "Protocol Technical Assistance" as your desired service, please describe your health systems' current stage of protocol development (i.e. no protocol, protocol in-progress, protocol developed but not implemented fully, protocol developed and implemented)?

If you selected "Human Trafficking Curriculum Consultation/Customized Training" as your desired service, please describe your health systems' current human trafficking curriculum/training offerings (i.e. no curriculum/training in place, curriculum/training program in-progress, curriculum/training developed but not implemented fully, curriculum/training developed and implemented)?

If you selected "Other custom consultation" as your desired service, please provide as many details as possible about both your organization's current programmatic offerings as well as which programmatic areas you are looking for HEAL to support.

What is your total budget for technical assistance consultation? *

Would you be interested in working with HEAL to identify additional funders? *

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