Monthly Data Clinic Application
Thank you for your interest in a Data Clinic!

Our team meets on the first Monday of each month to process applications and schedule sessions on a rolling, first come first served basis. We will follow up about your Data Clinic one month (at most) after we receive your application.

While we do prioritize first time applicants, organizations that have already participated in a Data Clinic may apply for a second session as long as 6 months have passed since your initial meeting, and you have taken your project/data question to the next level.

Please contact Becky (rebecca.wurwarg@maine.edu) with any questions.

Email address *
Organization
Your answer
Contact Name
Your answer
Address
Your answer
Phone
Your answer
Website
Your answer
Mission (Program Description)
Your answer
Geographic Service Area (town/city, county, region, state+)
Your answer
Number of staff (include FT and PT)
Your answer
In what sector does your organization primarily work? *
Monthly clinics are offered from 10:00am - 12:00pm at the Wishcamper Center on the University of Southern Maine campus in Portland, ME. Please indicate all the dates when you and your team are available. Please apply even if none of these dates work for you, and we will reach out to find a time. *
Required
Does your organization or program have a theory of change/logic model? *
Does your organization or program have a current strategic plan, marketing plan, continuous quality improvement plan, data collection plan or evaluation plan? *
What two topics would you most like to discuss during a clinic? *
*
Please describe more specifically your data issue(s) or question(s). *
Your answer
Is there any other information we need to know about your data or evaluation needs?
Your answer
After reviewing this application, we will contact you to confirm a slot and request additional materials. If you have any questions, please contact Becky Wurwarg at rebecca.wurwarg@maine.edu.
A copy of your responses will be emailed to the address you provided.
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