Technical Assistance (TA0 Request Form

^Broadband Technical Assistance (TA) Request Form

Section III – Description of Technical Assistance Request

Is your issue related to broadband deployment, digital inclusion/broadband adoption or both?

Please describe the broadband deployment and/or digital inclusion/broadband adoption issue(s) your organization would like to address.

Please provide a brief description of the type of technical assistance requested. If you are unsure about the specific type of technical assistance you would like, please indicate so. (Examples: building partnerships with ISPs, identifying areas for broadband infrastructure expansion, implementing telehealth initiatives, drafting a strategic plan for broadband, conducting targeted outreach, developing digital literacy programs)

Section II – Community Profile

Communities or Services Areas (e.g., City, State, Zip Code)

Section I – Requestor Information

Date

Organization Name Organization Location (City, State) Organization Type

First Name Last Name Job Title Email Phone

To request broadband technical assistance from National Telecommunications and Information Administration (NTIA) staff, please provide information in the form below about your community, the issue(s) you are facing, and details about the type of technical assistance requested. All questions are required.

Please specify which support areas related to broadband deployment you are interested in addressing. (Check all that apply)

Planning		Implementation		Operations		Assessment
	Business Case		Vendor Selection		Permitting Guidance		Data Analysis
	Community Assessment		Vendor Management		Network Monitoring		Impact Assessment
	Feasibility Study		Data Collection		Network Maintenance		Network Expansion
	Budgeting				Network Troubleshooting
	Stakeholder Outreach				Customer Acquisition
	Network Design				Pricing Strategy
	Funding / Financing
	Procurement Guidance

Other

Please specify which support areas related to broadband adoption you are interested in addressing. (Check all that apply)

Planning		Implementation		Operations		Assessment
	Business Case		Vendor Selection		System Updates		Data Analysis
	Community Assessment		Vendor Management		Equipment Refresh		Impact Assessment
	Demographic Analysis		Curriculum Development		Training Logistics
	Adoption Barriers		Training Evaluation		Certifications
	Budgeting		Outreach Incentives
	Stakeholder Outreach		Data Collection
	Training Strategy
	Funding / Financing
	Procurement Guidance

Other

What are your goals and expected outcomes for the broadband effort?

Section IV – Reference

How did you hear about BroadbandUSA’s technical assistance services?