MagellanOfAz.com

Program & Services

On-Site Learning Request Form

Contact Information
Needs and Type of Assistance

  1. Please write a clear description of the proposed technical assistance activity that would meet the need(s) and how the requestor anticipates benefiting from the assistance.

Type of Training

How Request relates to Your Agency's Goal

  1. Statement of how the proposed technical assistance would help enhance staff skills, service delivery, and goals of your organization. Check all that apply.





Resources you can provide (if training will be held at your facility)



Expected Outcomes

Please be aware that we can not guarantee the confidentiality or security of e-mail. Please do not send any information that you would consider confidential through this e-mail form.

You may also fill out the comments card that was included in your member handbook.


If you have any questions about your services, please call Magellan at (800) 564-5465, TTY (800) 424-9831. If you are in crisis, call the Maricopa Crisis Line at (800) 631-1314, TTY (800) 327-9254. For emergencies, please always dial 911.



This page last updated: Wednesday, March 24, 2010.