Request Employer Technical Assistance (TA)

Your Information

Primary Contact: First Name*

Primary Contact: Last Name*

Organization / Agency Requesting TA*

Address*

City*

Zip Code*

Primary Phone Number*

Email*

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Request Type

The section below is a place for you to let us know what kind of TA you are requesting and some general information about your organization/agency.

Technical Assistance Requested*

Hiring or Developing a Job Description
Organizational Readiness for the Employment of a CPS/CPPS
Preparing Staff for the Inclusion of CPS/CPPS
Discussing the WIPSEI Employer Guidance
Supervision Supports for Supervisors of CPS/CPPS
Discussing Options for Privately Funding a CPS/CPPS Training
General Information about the Wisconsin Peer Specialist Employment Initiative (WIPSEI)
Specialized Professional Development and Staff Training
Other

Please check all that apply.

If you selected "other" for the above question, please specify:

Do you currently employ Wisconsin Certified Peer Specialists?*

Yes
No

If "yes," how many CPS do you employ?

If “no," when are you planning to hire CPS?

Do you currently employ Wisconsin Certified Parent Peer Specialists?*

Yes
No

If "yes," how many CPPS do you employ?

If “no," when are you planning to hire CPPS?

In what programs do current CPS/CPPS you employ offer services? If you do not currently employ CPS/CPPS, in what programs do you hope to see CPS/CPPS offering services?*

Please answer.

What type of funding source do you use or hope to use?*

Please describe.

Digital Signature (Type Full Name)*

Staff working on the Wisconsin Peer Specialist Employment Initiative will follow up to discuss your request in the near future! Please ensure all required questions (marked with an asterisk) are answered before submitting.

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Employer Technical Assistance (TA) Request Form

Your Information

Request Type

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