General Assistance Request

Use this form to request consultation or feedback for such topics as gang assessment projects, determining best-suited approaches for gang-violence prevention and intervention initiatives, as well as feedback for gang-reduction initiatives already in progress within your community. Services are conducted via phone, email, and, when available, on-site consultation by NGC staff members, peer trainers, and subject-matter experts.

SECTION I—Requestor Information

Requesting Agency/Organization

Requestor’s Name

Requestor’s Title

Street Address

City

State

ZIP Code

Phone

Requestor’s Email Address

Website (optional)

SECTION II—Description of Consultation Request

Statement of Need

Describe, as specifically as possible, the condition or issue for which the consultation is requested.

Previous Efforts

Have there been any previous attempts to address the condition or issue for which this consultation is requested? If so, what action(s) were taken and what were the results?

Type of Assistance

Describe what type of consultation or guidance you would like to receive. Include specific topics or areas of expertise that would be helpful for the purpose of this request.

Intended Recipients

Describe the intended recipients of this consultation.

Objectives and Outcomes

What, specifically, would you like to achieve as a result of this requested consultation?