Materials Request Form for WNC Providers

Materials Request Form for WNC Providers

Please note that all requests require a minimum of 48 hour turn around time to obtain materials from the Triple P WNC storage facility and at least 1 week for USPS delivery. If you need your materials sooner, please contact the Triple P WNC Area Lead assigned to your county

Buncombe, Haywood, Madison, McDowell, Mitchell, Swain, and Yancey Counties

Sarah.Clark@Mahec.net

Clay, Cherokee, Jackson, Graham, Henderson, Rutherford, Transylvania, Polk, Macon, and Burke Counties

Erin.Edwards@Mahec.net

Are you a Western North Carolina Triple P provider*

Select

We are only able to provide resources to providers in our 17 county region. Please refer to your Triple P Provider Portal for outside requests;

https://www.triplep-parenting.net/provider/provider_login/en/

Date Materials Requested*

Last Name*

First Name*

Email*

Agency*

County or counties you provide services In*

Select

Have you submitted Data in past 12 Months?*

Select

If no, why?

Please select best fit

Select

Additional Information

Please indicate why you have not been able to submit data within the past 12 months

Triple P Trained Levels*

Select

L2 Seminar 0-12 Tip Sheets

Select

L2 Seminar Stepping Stones

Select

L2 Seminar Teen

Select

L3 PC Positive Parenting Tip Sheets

Select

L3 PC Infants Tip Sheets

Select

L3 PC Toddler Tip Sheets

Select

L3 PC Preschoolers Tip Sheets

Select

L3 PC School Age Tip Sheets

Select

L3 PC Other Materials Requests

Select

L3 PC Tip Sheet Bags

Select

L3 Primary Care Stepping Stones (SS) Materials

Select

L3 Teen Tip Sheets and Materials

Select

L3 Discussion Group Materials

Select

L3 Discussion Group Teen Materials

Select

L4 Standard

Select

L4 Standard Teen

Select

L4 Standard Stepping Stones

Select

L4 Group 0-12

Select

Optional Relevant Tip Sheets

Please indicate which Tip Sheets you would like below

Level 4 Group Teen

Select

Level 4 Group Stepping Stones

Select

L5 Enhanced

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L5 Pathways

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L5 Family Transitions

Select

L5 Lifestyle

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Quantity*

Please indicate the quantity of materials you are requesting (Ex: 5 of each tip sheet, 5 of each workbook, and 2 of each parent bag)

Date Materials Are Needed By*

Mailing or Drop Off Address

Based on the location that the materials are needed, we will either mail them or drop them off. Please be sure to include the full street address, City, State, and Zip Code

Are you interested in Parent Bags

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