TA Intake Form

Please complete the technical assistance form, providing as much detail as possible on the work you are doing and the support you seek. All TA requests require approval by BDAS before initiation of work.

Technical Assistance Request Form

"*" indicates required fields

Name*

First Last

Organization*

Email*

Primary Phone*

Are you currently receiving funding from the NH Bureau of Drug and Alcohol Services?*

Yes

What would you like TA to help you accomplish?*

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This field is for validation purposes and should be left unchanged.