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RTTC Training and Technical Assistance Request
Please complete the following form to provide us with your contact information and assist us in helping you choose the right telementoring model or models and tailor it to the needs of your community.
An RTTC Training and Technical Assistance (TTA) Navigator will be in touch to further discuss your needs and determine which TTA activities will best serve your program.
Join us in transforming rural health through telementoring!
First name
*
Last name
*
Organization name
*
Organization state
*
Organization zipcode
*
Type of Organization
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Please Select
Community Health Center
Government
Health Maintenance Organization (HMO)
Hospital - Community
Hospital - Academic Medical Center
Hospital - Other
Industry
Military
Non-Governmental Organization (NGO)
Practice - Group
Practice - Individual
Professional Society Employee
Public Health
Veterans Affairs
Other
Phone number
*
Email
*
How did you hear about the RTTC?
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Web search
Bulk email
Colleague
Conference presentation
News story
Social media
Other
Is this request for training?
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No
Yes
I am not sure
This request is related to:
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A new program
An existing program
Please describe what you would like the TTA process to focus on:
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Program design
Launch preparation
Scaling and sustainability
Evaluation
Other
Submit