Technical Assistance Request Form

Thank you for your interest in working with the New England Environmental Justice Thriving Communities Technical Assistance Center (EJ TCTAC). To request technical assistance, please complete the following form. It should take about 10-15 minutes to complete. One of our outreach staff will connect with you within a week to schedule an intake call and learn more about your request.

If you would like to complete this form offline, please access our technical assistance request intake form template at the link below and email the completed form to environmentaljustice@uconn.edu.

Technical Assistance Request Form

Part 1: About You & Your Organization

Name(Required)
Email(Required)
Write N/A if not applicable
Write N/A if not applicable.
Which of the following best describes your business/organization?(Required)
Select all that apply.
Preferred Method of Communication(Required)

Part 2 – About Your Community

Please provide the following socio-demographic information for the impacted community or communities for which you are seeking technical assistance.
Location of community(Required)
This field is for validation purposes and should be left unchanged.