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Office of Community Services skip to primary page contentIncreasing the Capacity of Individuals, Families and Communities

Technical Assistance

Learning Styles | References

Technical Assistance Evaluation Form
Compassion Capital Fund (CCF) National Resource Center

     
Intermediary Name:   Request #:
Contact: Request Date: Call Date:
Nature of request:    
     
1. Request Details – Phone call with the intermediary to clearly understand the situation as presented by the intermediary
   
  On a scale from 1 to 5, please rate the severity of the problem for your organization.
 
Not severe Somewhat severe Very severe
1 check box 2 check box 3 check box 4 check box 5 check box
   
2. Problem/Need – With the NRC team, describe the one or more root causes driving the symptoms
   
  Describe the problem or need as the NRC staff understands it.
   
  How have you tried to address this?
   
3. Solution Alternatives – NRC generates solutions that address the symptoms and, where possible, the problem/need
   
  What have other intermediaries done to address the symptoms and/or address the causes?
   
  List solutions presently available to the NRC that can be purchased, borrowed, or rented:


  Solution
Subject matter experts

 

  
Publications, books, software

 

  
Solutions "owned" by the government or DMT

 

  
Other:

 

  
   
  What are the time requirements for a successful solution?
   
 

How will you know you have a successful solution? What will look different quantitatively?

   
4. Interim Activity - First step in providing a solution
   
5. Follow-up

Learning Styles | References