National Resource Center for Child Welfare Data and Technology

National Resource Center for Child Welfare Data and Technology

A Service of the Children's Bureau/USCHHS
Child Welfare League of America

Peer Consultation Request Application

Complete the request and return application to:

NRC-CWDT
Child Welfare League of America
2345 Crystal Drive
Suite 250
Arlington, VA 22202

The NRC-CWDT is pleased to provide an opportunity for child welfare professionals to become Peer Consultants. Peer Consultation is a process where child welfare professionals from various States are able to directly share their unique ideas on policy evaluation, resources, problem-avoidance, and best practice through focused on-site technical assistance with other States.

Your expertise and unique perspective will serve as a valuable resource for others working in child welfare systems. Please complete the form and the State Advisors will use the information to select appropriate Peer Consultant(s) for requests from States.

Thank you for your interest in becoming a Peer Consultant and we look forward to your contributions to the network of child welfare professionals in information technology.

Agency Contact Person: __________________________________________

Agency/Organization Name: _______________________________________

E-mail Address: _________________________________________________

Mailing Address: _________________________________________________

City: _______________________________ State: ______ Zip: __________

Phone Number: __________________ Fax Number: ____________________

Peer Consultation Topic Area(s)
Please note it is in the best interest of the State to limit each Peer Consultation visit to one subject. For examples of Peer Consultation please view the Peer Consultation Technical Assistance Example page.

I would like to request a peer consultant for the following topic area(s):

___________________________________________________________________

What need within your organization prompts your request?

___________________________________________________________________

Do you want Federal participation (Regional Office staff or Federal Office staff)?

___________________________________________________________________

Proposal Description
Help us to better understand your needs by responding to the questions that follow. The proposal should be no longer than two pages and should be submitted with this application.

___________________________________________________________________

How many State staff will be involved?

___________________________________________________________________

What will be their role in the Peer Consultation process?

___________________________________________________________________

What specific responsibilities, time frame, and desired outcomes can be used to help define the Peer Consultation needed?

___________________________________________________________________

Have you identified a specific peer consultant with whom you would like to request?

___________________________________________________________________

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