Request for Technical Assistance
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Type of Technical Assistance Requested
*
Recovery Housing
Transportation
Employment
Other
Technical Assistance request- please give general information on the help you are seeking
*
What counties do you work with
*
Bradford
Centre
Clinton
Columbia
Lycoming
Montour
Northumberland
Potter
Snyder
Sullivan
Tioga
Union
Other
I work with
*
SCA
Treatment center
Recovery Organization
Recovery Community Center
Person in recovery
Other
Submit
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