CYFD-BHS and COI Contractor Submission and Request Form

For COI Contractors and CYFD Staff to request training dates, access grant funds or submit necessary documentation to the COI

"*" indicates required fields

Type of Request*

New Training Request

Cancel or Change Existing Training

Submit Sign-in Sheet or Meeting/Event log

Request Grant Funds

Your Name*

First Last

Email*

Enter Email Confirm Email

Phone*

Program/Training*

Program/Training Other

Please provide

Wraparound Training Topic*

Trainer(s) Name*

If not sure, put “unknown”

Has a specific date for training been determined*

If you say “no” we will work with you to identify a date.

Yes

Date & Time*

Please provide the start/end dates and times below. To add multiple dates for the same training request click the “+”

Date or Date Range

Times

Training Audience*

Please select the most appropriate choice

Invite only, list will be provided

Limited to a specific community or provider site

Open to the public

Other

Details/Further Instructions*

Please provide any details with regards to the intended audience for this training and how they will be informed. If you want the COI to provide marketing (flyer/email) please indicate.

Please provide the original training information*

Training Title

Training Date(s)

Cancel or Reschedule*

If you select Cancel we will cancel the training and you will need to submit a new training form at a later date if you want to reschedule.

Cancel

Reschedule

New Date & Time*

Please provide the start/end dates and times below. To add multiple dates for the same training request click the “+”

Date or Date Range

Times

Details/Further Instructions

Please provide any additional details with regards to changes needed.

Submission Type

I have a sign in sheet to upload

I will manually enter the attendees

I dont have individual attendee information but can provide a summary

Event Type

Wraparound Coaches Learning Community

Wraparound Provider Meeting

Family Peer Support Coaching Meeting

YouthMOVE Hangout/event

Training

Other

Training Title*

Other Meeting or Event Title*

Attendee List

Click the plus sign to add additional rows

Name

Role/Title

Agency/Organization

Names not available-Attendee Summary

If you do not have individual information for the attendees please provide as much information about who attended, what role they play (provider, youth, CYFD staff, etc) and how many of each role.

Date & Time*

Please provide the start/end dates and times below. To add multiple dates for the same training/event submission

Date or Date Range

Times

Sign-in Sheet or Attendance Log Upload

Drop files here or

Max. file size: 100 MB.

Wraparound Coaches

Arturo Calderon

Caitlin Goodwin

Codi Quevado

Cynthia Gerardo

Elizabeth Macias

Elizabeth McBride

Gloria Goree

Haley Garcia

Jessica Orozco

Kimberly Brown

Krystal Perez

Leon Cavazos

Michelle Hargraves-Zamarron

Nicole Lewis

Rosella McCaffrey

Sabrina Aranda

Steve Johnson

Tarra Toledo

Victoria Savage

Other (guests)

Wraparound Non-Coaches

Bob Brazell

Brian Isakson

Collin Slutzky

Jessica Wolf

Lacy Keith

Nayheem Khan

Virginia Whitfield

Please list the full names of any additional attendees at this meeting

Purchase/Request Type*

Materials or Supplies

Payment Request**

Registration Fee

Other

**A payment request is when a specific dollar amount is being paid to an individual or group of individuals according to pre-established guidelines following program and grant requirements.

Describe Other*

Purpose of Purchase*

Request is related to a specific training or event

Request is related to a general/internal staff need

Other purpose

Funding Source

The Manager for these funds will be contacted to approve request.

Service Array (State Funds)

SOC Grant

HTEP Grant

Not sure

Describe Other Purpose*

Date of Training of Event*

If multi day put first day of event and provide date range in description box below

MM slash DD slash YYYY

Location of Training or Event*

If online please put Virtual

Title of Training or Event*

Participant Description*

Eg: Youth, CYFD Staff, Community Providers, etc.

Number of Participants at Event*

Details on reason for purchase*

Please provide details about purchase/fund request including how purchase is connected to grant or contract deliverable. Please add additional dates or other details about the reason the purchase is needed.

Description of Purchase*

Please provide as much detail as you can about the purchase, include what, how much and from where to purchase. Additional details, screenshots, links can be uploaded below. If you have a large order please DO NOT list all items here, please upload a spreadsheet with all requested items.

Payment Request*

Please enter the information below, to add more rows click the plus sign. If the payee has not been paid by NMSU before they will need to provide a W9 with a physical signature, you may upload it below or email it later.

Name

Phone Number

Dollar Amount

Dates/Times of Attendance if not full training

File

Max. file size: 100 MB.

Registration Fee Details*

Please list the name of the conference or training you would like us to register for.

Date of Conference or Training

MM slash DD slash YYYY

Attendance List

To request we register for multiple people please click on the plus sign to add rows

Name of Person Attending

Email of Person Attending

Registration Website

Additional Registration Instructions

Any other information we may need to process your registration request

Total Dollar Amount For This Request*

Other fund request details*

Please describe the request in as much detail as possible.

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CYFD-BHS and COI Contractor Submission and Request Form

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