test page 2 – MPATTC Learning

Your Name*
Your Email*
Enter Email Confirm 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)
Date Format: MM slash DD slash YYYY
Date
- Post on, or before the above date.
- Post ON the above date, exactly.

Event Posting
Would you like this event posted on the Mountain Plains ATTC site?*
- Yes
- No
Website Calendar
Would you like this event to be displayed on the event calendar?*
- Yes
- No
Title of Event
What is the name of your event?*
Date & Time
Is this an Ongoing event?*
Example: An online, self paced, course that is accessible at any time is considered "ongoing".
- Yes
- No
If this is an "ongoing" event that does not have a start or end date, consider using the dates of the grant/contract.
Start Date*
Date Format: MM slash DD slash YYYY
Start Time*
Please include AM/PM
End Date*
Date Format: MM slash DD slash YYYY
End Time*
Please include AM/PM
Time Zone*
- US/Mountain
- US/Central

Event Description and General Info
Provide a brief description of the event.*
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.
How many credit hours will this event include?*
Event Leader/Contact Person's Name*
Event Leader/Contact Person's Email*
List any co-sponsors for this event (if applicable.)

Reporting Information
Which of the following types 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
Do you want to build upon an existing event?*
This is for reporting purposes only...is this event related in some way to another event?
- Yes
- No
Previous Event Name
Do you want to attach a document?*
- Yes
- No
Upload your file for this Event Posting:
You can upload multiple documents. Files must be smaller than 16MB.
Drop files here or

GPRA Request
Contact Person for GPRA Request*
Contact Email Address*
Name of Trainer/Facilitator*
Delivery Method*
- Online
- Face-to-face
Date needed by*
Date GPRAs are needed in hand, not the same as date of training.
Date Format: MM slash DD slash YYYY
To whom will the package be shipped? (name of person)*
Address to ship to*
Street Address Address Line 2 City State ZIP Code
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
Do you need a trainer feedback summary report?*
- Yes
- No

SAMHSA Updates & Website Appearance
Should this product be included in SAMHSA's bi-monthly update? (Product)*
- Yes
- No
SAMHSA's Bi-Monthly Report Relation? (Product)
Please check all that apply:
- Intensive TA Efforts
- Opioid Epidemic
- COVID-19
- Tribal Communities
- N/A

Basic News Info
Title of the News Item*
Author
Other Author
Article and/or news item content:*
If there is a link to an external news item, please post that link here.
Link to article
Would you like to upload a file?*
- Yes
- No
Upload your file for this News Posting:
You may upload multiple files. Files must be 16MB or smaller.

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 Mailchimp template?
Upload any additional documents here:
You may upload multiple documents by continuing to click "select files".
Drop files here or

Name of Project
Example: Mailchimp Template 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?
Would you like to upload a document?
You may upload multiple documents by continuing to click on "Select Files".
Drop files here or

Would you like to include anyone else on the communications for this project? You may add up to 3 additional email addresses.
Additional Email 1
Additional Email 2
Additional Email 3

Event Posting