Tribal Wellness Court Training and Technical Assistance Request Form
Please take a few moments and use this form to request training and/or technical assistance for your Wellness Court from the Tribal Law and Policy Institute. If you have questions regarding this form, or need assistance completing this form, please call us at: 323-650-5467.
Date of this request: *
First and last name of person requesting assistance. *
Name of Tribe: *
Name of Wellness Court: *
Date Wellness Court established: *
First and last name of primary contact person on-site. *
Address: *
City: *
State: *
Zip Code: *
Telephone: *
Fax:
Email address: *
Is your Wellness Court currently receiving a BJA Drug Court Grant?
Clear selection
If yes, which type of grant are you receiving?
Clear selection
Please list all other funding:
Type of Wellness Court:
Clear selection
Next
Never submit passwords through Google Forms.
This form was created inside of Tribal Law & Policy Institute. Report Abuse