Technology Assistance Program - Signup Form Thank you for your interest in our Technology Assistance Program (TAP)! To be notified about future TAP programs, please fill out the brief survey below: Question Title * 1. First Name: Question Title * 2. Last Name: Question Title * 3. Email Address: Question Title * 4. Phone Number: Question Title * 5. City: Question Title * 6. State/territory: Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (DC) Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Question Title * 7. How do you prefer to be notified about future TAP programs? Phone Email No preference Questions, concerns, or need any additional assistance?Contact Nicole Jarvis, LMSW, Assistance Director of Programs, at njarvis@cew.org or 646-929-8043. Submit