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Team Lead Demographic Questions

Please allow 15-20 minutes to complete this form in one sitting. Applications will be closed on Friday, Feb. 2, 2024 at 11:59p.m. EST. 
 
SEE APPLICATION QUESTIONS
If you would like to view application questions before you begin, see the PDF of the application.

WHO SHOULD APPLY—TEAM LEADS
Team leads should complete the application form on behalf of all members of their organization who are interested in participating in this ECHO. The Team lead will be the main point of contact and should be an individual who can drive implementation/impact from the ECHO. 
 
We encourage organizations to apply for this opportunity and attend each session as a team, so they can benefit fully from this ECHO and gather the information needed to implement sustainable change. Ideally, this team should include: 

  • At least one lead clinician who provides clinical services and/or oversees clinical practices. 
  • An administrative staff person that oversees internal practices and policies.  
  • Team members who represent diverse roles and identities (mixture of administrators, managers and direct service providers with diversity in race, ethnicity, gender identity, age, etc.).  
  • At least one client/patient/consumer leader or advocate who receives services from your organization. 
Individual providers are also welcome to apply, even if they do not have a team or colleagues that can join them.  

QUESTIONS? Please check out our participant FAQ document or email us at integration@thenationalcouncil.org. 

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* 1. Team Lead Contact Information

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* 2. Role at Organization What best describes your role at your organization?

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* 3. Special Accommodations Do you (or anyone on your participating team) have special accommodation requests (such as an American Sign Language interpreter) that we should be aware of?

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