211: New/Expanded Initiative Request
Date of request
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Target date to launch/expand initiative
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Requesting organization
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Name/contact information of requestor
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Requesting organization mission statement
Are you making this request on behalf of another organization? If yes, name of organization originating request
Description of proposed initiative
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What would 211's role be in this initiative?
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Resources required to expand/launch initiative
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What 211 staff are needed for this initiative?
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Will this initiative require a new position to be created at 211? If so, describe the scope of work for this position.
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Is funding available for this initiative? If yes, provide amount.
Describe what training would be required, length of training, and who would provide the training.
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Would 211 be expected to collect:
Personally identifiable information
HIPAA Information
Would 211 be able to access a partner's software platform to collect this information? Specify name of system.
Is there a data sharing agreement in place between UWCM and the partner organization(s)?
Please attach any supporting documentation for review.
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