TYA4TC Educational Materials Request Form

Tribal Youth Ambassadors for Tobacco Control Project Educational Materials Requests

The educational materials of the Tribal Youth Ambassadors for Tobacco Control Project (TYA4TC) are geared to Native community members in Sonoma, Lake and Mendocino Counties.

If you are interested in any of our materials or resources, please fill out this form to receive access to the requested educational materials. For more information visit www.cimcc.org/tpp.

Our Health Education Specialist, Christina Inong, ASW, will respond to your request. She can be reached at christinacimcc@gmail.com.

Yahwi!

Question Title

* 1. Contact Information

Name

Address

City/Town

County

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Tribal Affiliations (select all that apply)

Big Valley Band of Pomo Indians of the Big Valley Rancheria

Cahto Tribe of the Laytonville Rancheria

Coyote Valley Band of Pomo Indians

Cloverdale Rancheria of Pomo Indians of California

Dry Creek Rancheria Band of Pomo Indians

Elem Indian Colony of Pomo Indians of the Sulphur Bank Rancheria

Federated Indians of Graton Rancheria

Guidiville Indian Rancheria

Habematolel Pomo of Upper Lake

Hopland Band of Pomo Indians

Kashia Band of Pomo Indians of the Stewart’s Point Rancheria

Koi Nation of Northern California

Little River Band of Pomo Indians of the Redwood Valley

Lower Lake Rancheria

Lytton Band of Pomo Indians

Manchester Band of Pomo Indians of the Manchester Rancheria

Middletown Rancheria of Pomo Indians

Mishewal Wappo Tribe of Alexander Valley

Pinoleville Pomo Nation

Potter Valley Tribe

Robinson Rancheria Pomo Indians of California

Round Valley Indian Tribes

Scotts Valley Band of Pomo Indians of California

She-Bel-Na Band of Mendocino Coast Pomo Indians

Sherwood Valley Rancheria of Pomo Indians of California

Yokayo Tribe of Indians

Other (please specify)

Question Title

* 3. What material(s) are you requesting? (please select all that apply)

Download Art Card

Download PowerPoint Presentation on Traditional Tobacco

Access to Video on Traditional Tobacco

Other (please specify)

TYA4TC Educational Materials Request Form

Tribal Youth Ambassadors for Tobacco Control Project Educational Materials Requests

Question Title

* 1. Contact Information

Question Title

* 2. Tribal Affiliations (select all that apply)

Question Title

* 3. What material(s) are you requesting? (please select all that apply)

Question Title

* 4. Please feel free to provide feedback on our educational materials, such as what you like about them or changes you'd like us to make to them.

Question Title

* 5. Questions/additional comments?