MPATTC Project Submissions - MPATTC Learning

1Basic Info

2Event Info

3Registration Info

4GPRA Request

5Product/Resource Details

6News Info

7Header Image

8SAMHSA Reporting

9Searchability

10Promotion Options

11Additional Info

12Project Details

13File Upload

14Project Communication

Your Name*

First Last

Your Email*

For which of the following are you providing information?*

Event - Website posting and/or GPRA Request

Website posting - Product or Resource

Website posting - News Announcement

Project that is not a website posting (i.e., 508 compliance or branding for powerpoint slides, documents, etc; requesting closed-captioning)

Project other than what is listed above (anything else that doesn't appear to fall into the above categories)

Due date:*

When do you want this information posted to the website or the project completed by? (GPRA due dates will be addressed later in this form)

Month

Day

Year

Date*

Post on, or before the above date.

Post ON the above date, exactly.

Would you like this event posted on the Mountain Plains ATTC site?*

Yes

No - This is only a GPRA Request

Event Title*

Start Date*

If this is an "ongoing" event that does not have a start or end date, consider using the dates of the grant/contract.

Month

Day

Year

Start Time*

Hours

Minutes

AM/PM

End Date*

Month

Day

Year

End Time*

Hours

Minutes

AM/PM

Webpage Details

Display on event calendar?*

Yes

Ongoing event?*

Example: An online, self paced, course that is accessible at any time is considered "ongoing".

Yes

Display end date and time on event details page?*

Yes

Time Zone*

US/Mountain

US/Central

Event Description*

This description will be posted on the MPATTC website. Please write in full sentences and include speaker names here if you would like them in the web promotion.

Do you need to provide a physical location/address for this event?*

Yes

Venue Name*

Event Address*

Street Address Address Line 2 City State ZIP Code

Event Type*

Online Course

Face-to-Face Training

Webinar/Virtual Training

Meeting

Virtual TA Session

Presentation

Virtual Job Fair

Conference

Project Echo

Other

What type of technical assistance best describes this event?*

Universal: information provided to independent users through their own initiative, resulting in minimal interaction with TTC staff. Examples: Mass mailings, publication of information (e.g. newsletters,) untargeted presentations to heterogenous groups, website, social media.

Targeted: Based on needs common to multiple recipients and not extensively individualized. A relationship is established between the TA recipient and one or more TTC staff. Examples: Online courses, webinar series for specialized groups, focused knowledge-sharing, communities of practice, short-term training, replication guides.

Intensive: Requires a stable, ongoing relationship between the TTC program staff and the TA recipient and is provided in accordance with a plan developed between the TTC and the TA recipient. Examples: Ongoing consultation in specific communities, states & systems.

N/A

Registration Deadline*

Month

Day

Year

Registration URL

Event Contact Email*

For registrants

Is this event GPRA'd or non-GPRA'd?*

GPRA (R8 ATTC Generated)

GPRA (Other TTC Generated)

Non-GPRA

GPRA Info

Date needed by*

Date GPRAs are needed in hand, not the same as date of training.

Month

Day

Year

Contact Person for GPRA Request*

Contact Email for GPRA Request*

Will these GPRAs be shared with another TTC?*

Yes

Please list which TTC(s) below;*

Name of Trainer/Facilitator*

How many credit hours will this event include?*

Do you need a trainer feedback summary report?*

Yes

Event Format*

Virtual

In-Person

Hybrid (Virtual and In-Person)

Other

What is the estimated number of participants?*

To whom will the package be shipped? (name of person)*

Address to ship to*

Street Address Address Line 2 City State ZIP Code

Event Type (GPRA)*

Presentation or Training (Presentation: delivery of awareness, information/explanation related to an idea, apractice, or a new product to an audience delivered in person, virtual/webinar, private audience or in a major local or national conference. Training: teaching of a skill, knowledge, or experience for personal or professional development; etc.)

Meeting (Assembly of individuals or committees for discussion of a specific topic or planning)

Technical Assistance (Negotiated series of activities designed to reach a valued outcome via sharing of information and expertise, instruction, skills training, transmission of working knowledge, consulting services or the transfer of technical guidance or data.)

Event Primary Audience (check all that apply):

Professionals or Organizations (Practicing professional and paraprofessional healthcare providers, including substance use and mental health prevention, treatment, recovery, and peer support services, or staff of local, state, tribal, and other healthcare organizations; counselors; social workers; case mangers; faith leaders; and criminal justice/law enforcement professionals)

Students or Educators (Including faculty, administrators, supervisors, etc.)

Community Members (Members of a community or consumers)

American Indian and Alaska Native Tribes

Hispanic and Latino Communities

Rural Communities (Activity dedicated to rural residents or providers serving rural communities)

Additional person you would like to receive the GPRA link

Please provide email address

Second additional person you would like to receive the GPRA link

Third additional person you would like to receive the GPRA link

Product/Resource Title*

Product/Resource Description*

This description will be posted on the MPATTC website. Please write in full sentences and include any information here if you would like them in the web promotion.

Product Language*

English

Spanish

Other

Type/Format of Product*

Toolkit

Print Media (Brochure, Monograph, Report, Poster)

Multimedia (Video, Webinar Recording, Podcast)

Website

Curriculum Package

eNewsletter or Blog

Interactive Resources

Mobile App

Presentation Slides

Other

Target Audience*

Medical Professional (Physician, Nurse, Physician Assistant)

Recovery Specialist

Student

Administrator

Criminal Justice Professional

Addictions Counselor

Educator

Other

Publication Date*

Month

Day

Year

Provide the link to the product (if there is one):

News Title*

Article and/or news item content:*

This description will be posted on the MPATTC website. Please write in full sentences and include any information here if you would like them in the web promotion.

Author

Link to article

An image is required for all news postings, how would you like to include your image?*

Upload an image

Link to an image

Describe an image to use

News Image (Upload)*

Accepted file types: png, jpg, jpeg, Max. file size: 64 MB.

News Image (Link)*

News Image (Description)*

Should this be included in SAMHSA's bi-monthly update?*

Yes

N/A - This is only a GPRA Request

SAMHSA's Bi-Monthly Report Relation?

Please check all that apply:

COVID-19

Intensive TA Efforts

Opioid Epidemic

Rural Communities

SAMHSA Awareness Event

Stimulants

Tribal Communities

What Awareness Event does this address?*

Name of the tribe or tribal organization (or multiple tribes)*

Type of participants/providers served*

Brief Statement of Purpose (1-2 sentences)*

External Partners/Collaborators (Enter NA if none)*

These questions are not required if you are only requesting a GPRA link.

Which keywords apply to this product/resource?

Mark no more than five:

Adolescents/Youth

African American

Alcohol Misuse/Use

ASAM (patient placement/assessment)

Asian Americans & Pacific Islanders

Binge Drinking

Biology/Neurobiology of Addiction

Clinical Supervision

Co-Occurring Disorders

Community-Based Organizations

COVID-19/Coronavirus

Criminal Justice

Cultural Competency/Humility

Diversity

Domestic Violence

Ethics/HIPAA/Confidentiality

Evidence Based Practices

Faith-Based Initiatives/Spirituality

Fentanyl

Grief

Harm Reduction

Health Equity

Healthcare

Hepatitis C/HCV

Heroin

Hispanics/Latinos

HIV/AIDS

Homelessness

Implementation Science

Implicit Bias

Integration

Leadership Development

LGBTQ

Marijuana

Men

Mental Health

Motivational Incentives/Motivational Interviewing

Narcan

Native Americans

Older Adults

Opioids

Organizational Change

Outreach Workers

Overdose

Pandemic Response

Pharmacological Interventions/MAT

Pregnancy

Prescription Drugs

Problem Gambling

Recovery Oriented Systems of Care

Recovery Support Services

Recurrence/Recovery Management

Rural Settings

SBIRT

Stigma

Stimulants (Cocaine/Methamphetamine)

Stress

Students/Pre-Service Training

Suicide

Technology Transfer

Telehealth/Tele-Behavioral Health

Tobacco

Training & Skill Development

Trauma

Treatment Planning

Vaping

Veterans

Women

Workforce Development Strategies

Collaborating TTC (check all that apply):

MHTTC and PTTC centers are not available to select on the web portal.

Central East ATTC

Great Lakes ATTC

Mid-America ATTC

Mountain Plains ATTC

New England ATTC

Northeast & Caribbean ATTC

Northwest ATTC

Pacific Southwest ATTC

Southeast ATTC

South Southwest ATTC

Southeast Asia-HIV ATTC

Vietnam-HIV ATTC

South Africa HIV ATTC

Ukraine and Central Asia-HIV ATTC

National American Indian and Alaska Native ATTC

Demo Group

ATTC Network Coordinating Office

Global ATTC

National Hispanic and Latino ATTC

Intranet

Would you like this to show on the homepage?*

Yes

N/A - This is only a GPRA Request

Would you like this to stay at the top of the homepage list?*

Items are shown chronologically by default

Yes

In addition to having this information posted to the MPATTC Website, do you need to request anything else be done with the information? Please describe your request here, including as many details as possible. Leave blank if none.

For example, do you need a marketing graphic created, or a document formatted?

Name of Project*

Example: Flyer for Leadership Academy

Please describe the project:*

Please use this field to describe your request. Include as many details as possible.

Would you like to add a link?

Would you like to add another link?

These questions are not required if you are only requesting a GPRA link.

Document Upload

If you have any documents to upload do so here, you may upload up to four documents.

Drop files here or

Max. file size: 64 MB, Max. files: 4.

Document Link

If you have any documents to link to do so here.

If you included a document, is it 508 compliant?

Yes

Additional Email 1

Would you like to include anyone else on the communications for this project? You may add up to 3 additional email addresses.

Additional Email 2

Additional Email 3