Request for Services

To request any of the services and trainings provided by The Nominal Group, please complete the "Request for Services" form below.  The Nominal Group, Inc. will make every attempt to honor the requested date(s).  However, if the actual date(s) of the proposed training conflicts with other trainings scheduled, you will be notified immediately.  Information about the fees for the services and trainings provided by The Nominal Group can be requested by writing to us at thenominalgroup@aol.com or info@thenominalgroup.org

 

 

Agency/organization name
City
State

Describe the target population served by your agency. (e.g. women of color, gay, bisexual)

Please describe the racial/ethnic make-up of the target population your organization/agency serves. Please use only numbers.

NameMaleFemale
African American
Alaskan Native
American Indian
Asian/Pacific Islander
Caucasian/White
Hispanic/Latino
Other (Please specify)
 

Please describe the age of the target population your organization/agency serves. Please use only numbers.

 
Under 10
11-15
16-19
20-29
30-39
40-49
50 or older
 

Describe the type of services your organization/agency provides. (Check all that apply)

Advocacy
Counseling
Education/Prevention/Risk Reduction
Housing/Housing Assistance
Primary Care
Other (please specify)
 

Please select the type of capacity-building technical assistance training preferred. (Please select only one)

Staring a non-profit 501(c)(3) organization
Board development and training
Organization pre/post funding management
Grants writing and management training and services
Program planning and development
Grants Management
Program Evaluation
 

Which of the following best indicate the desired training length? (Please select only one)

1/2 day
1 day
1 1/2 day
2 days
3 days or more
 

Which of the following training formats will best meet your organization/agency technical assistance training needs? (Please select only one)

On-site training
Work with a TNG consultant
Other (please specify)
 

After the first training, would you like follow-up training? (Please select only one)

Yes
No
 

If yes, how often would you like follow-up training? (Please select only one)

Quarterly (every 4 months)
Biannually (every 6 months )
Yearly (once a year)
 

Please list desired training date and two alternate dates.

Desired Date
Alternate Date 1
Alternate Date 2
 

Please provide the name, job title, complete address, telephone number and fax number of the person making this request.

Name
E-mail
Job Title
Address
State
Zip
Telephone
Fax