Bring the HEAL Trafficking Technical Assistance Consultancy Team to Strengthen Your Health Care Anti-Trafficking Work
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.
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Email *
Organization *
Name of organization point of contact *
Phone number of organization point of contact *
How did you learn about HEAL Trafficking? *
Do you participate on any HEAL listserv? Please check all that apply: *
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HEAL Trafficking provides a variety of technical assistance services. Please select your desired service(s) from the list below. *
Required
Please select whichever description best describes your organization. *
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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