The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

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The value you provided must be within the suggested range

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Required format:

HL BH CoE TTA Request

Thank you for reaching out for training or technical assistance related to the implementation of culturally and linguistically appropriate behavioral health practices for Latine populations. This brief form will help us gather information about you, enabling us to create a more detailed offering that aligns with your specific needs.

The Hispanic/Latino Behavioral Health Center of Excellence has a wide range of experts available through our consultants, subject matter experts, partner organizations, and our steering committee. Leveraging the knowledge and skills of these experts, we are committed to providing up-to-date training, technical assistance and widely available resources. By completing this TTA request form, we can customize assistance tailored to your specific needs and requests.

Expect to be contacted within 48 business hours after submitting this form. If you encounter any issues or have urgent needs before then, please reach out to hlbhcoe@uccaribe.edu .Thank you!

*Please be aware that the Hispanic/Latino Behavioral Health Center of Excellence is unable to assist in obtaining grants or funding for your organization. The Center focuses on providing no-cost training and assistance to help establish, develop, or implement your services, enhance workforce development, consult and share evidence-based best practices.

First Name

Last Name

Preferred Pronoun for Communication

She/Her

He/His

They/Them

reset

Name of Organization or Individual Requesting Assistance

Role/Job Title

Email Address

* must provide value

Best Contact Phone

Preferred Communication Method

Phone

Either

City

State

Type of Organization (CBO, University, Treatment Center, etc.)

To which Latine populations does you or your organization currently provide services?

People currently experiencing mental health challenges

People currently experiencing substance use challenges

People living with co-occurring disorders (mental/physical/psychiatric/substance use)

People living with serious mental illness (SMI) and severe emotional disturbance (SED)

People requiring services in Spanish

People living with Disabilities

Infants and Young Children

Elders/Older Adults

Adolescents and Transitional Age Youth

refugee, and migrant populations

Faith-based communities

People currently or formerly involved with the justice system

People who identify as LGBTQ+

People experiencing homelessness

People living in rural or remote areas

People living in urban areas

People who are uninsured or underinsured

postpartum, and parenting people

caregivers, and families

Veterans or active-duty military personnel

General population (may include many of the above - not focused on specific community or population)

Other (specify)

Other (specify):

Expand

For which type of service provider is your organization seeking training and technical assistance?

Psychologists

School Psychologists

Clinical Social Workers

Mental Health Counselors

Substance Abuse Counselors

Marriage and Family Therapists

Psychiatrists

Case Managers

Community Health Workers

Peer Recovery Specialists

Nurse Practitioners

Occupational Therapists

In which language would your organization like to receive the training and technical assistance (TTA) services?

English

Spanish

Other (specify)

Other (specify):

Expand

Do you feel your need falls into any of these categories? If not, please choose other and list your desired area of assistance

Integration of Culturally Responsive and Linguistically Appropriate Services

Workforce Development

Community Organization and Engagement

Evidence-Based Practices

Other (specify)

Other (specify):

Expand

Please elaborate on your need:

Expand

What do you hope would be different as a result of this training or assistance?

Expand

How did you hear about the Hispanic/Latino Behavioral Health Center of Excellence (H/LBH CoE)?

H/LBH CoE Training or Event

Colleague

Exhibit

Online Search

Social Media

Other (specify)

Other (specify):

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