STAR Center | Technical Assistance Request Form

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Technical Assistance Request

Please complete the form below to submit your request to the STAR Center:

Your Name*:
Organization:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Phone*:
FAX:
E-mail address*:
Web site:
Please select all that apply: I am a:
	Consumer
	Family Member
	Academic (teacher, researcher, student)
Other:
My organization is:
	Consumer-run organization or group
	State, county or local mental health authority
	Federal government agency
	Academic institution
	Provider organization
	Media
Other:
Type of technical assistance requested:
	Verbal information
	Materials
	Referrals
	Training
	Consultant
Other:
Additional Information:

*Required

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With grateful acknowledgment to the federal Center for Mental Health Services (CHMS).
CMHS was established under the 1992 ADAMHA Reorganization Act, Public Law 102-321, which mandates CMHS' leadership role in delivering mental health services, generating and applying new knowledge, and establishing national mental health policy. CMHS is a component of the Substance Abuse and Mental Health Services Administration (opens in new window), U.S. Department of Health and Human Services (opens in new window).

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Please select all that apply:

*Required