Form 1 Implementation Project Information

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IP ID Number: IP434534

Implementation Project Information Form
Prefilled – able to edit

IP Title*

Select States/Tribes/Territories

State/Tribe/Territory participating in IP*

AL
AK
AR
CA
CO

Added States/Tribes/Territories

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Click to ADD >>
<< Click to REMOVE

If other than the State/Tribal child welfare agency, specify the primary participant(s) in the IP (e.g., county or local jurisdiction, court, private
agencies operation on behalf of the state, etc.)

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Region*

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Brief Description of the Implementation Project*

Re-attach Abstract
(if revised)

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Project Duration

Years

Project Start/End Dates

Start

Estimated Project Budget

Year 1

IC Contact Info*

Months
mm/dd/yyyy

End
Year 2

mm/dd/yyyy
Year 3

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Email* Prefilled - Able to Edit

State/Tribe Contact Info* Prefilled - Able to Edit

Email* Prefilled - Able to Edit

Year 4
Phone*

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Phone*

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Additional Network Members Needed to Deliver T/TA
Added Members

Select Network Members

Child Welfare – Youth Development

Child Welfare – Organizational Improvement
Child Protective Services
Child Welfare – Legal and Judicial Issues
Family – Centered Practice and Permanency Planning
Child Welfare Data and Technology

Practice Area(s)*

Organizational/
Systemic Area(s):*

Select one

IP Logic Model Attached*

TTA1

<< Click to REMOVE

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NRC/IC Optional Category

IC 1

Click to ADD >>

NRC/IC Optional Category #2
Yes

No

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Select all that apply

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NRC tabs for Implementation Projects
will be the same as NRC T/TA Work
Plan form tabs

TTA2

Save List

Brief narrative description of activities planned

Workplan attached*
State/Tribal Contact*

Yes

No

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Email*

Prefilled - Able to Edit

Prefilled - Able to Edit

Phone*

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Optional Field:

Optional Field:

Cancel

Save

IP CLOSE OUT
Yes

Has this implementation project concluded?

No

Date T/TA work completed
Further T/TA expected to be needed
Name of Closer*

Yes

No

Date of Closeout*

mm/dd/yyyy

Comments/Notes

IC IP Information

6