Jail-based MAT Mentee Site Initiative Application

Jail-based Mentee Site Selection Application

Submission Deadline

The Jail-based Medication-assisted Treatment (MAT) Mentor Site Initiative offers a unique opportunity for jails across the country that are interested in providing MAT services to observe and learn from established and innovative programs that have demonstrated successful outcomes. The mentor initiative is part of the training and technical assistance (TTA) available to local jurisdictions through the Bureau of Justice Assistance’s COSSUP. The initiative is being coordinated by a COSSUP TTA provider.

Upon receipt of your application, the TTA provider will send a confirmation email to you.

Questions
Should you have any questions about the application process or issues with submission, please send an email to info@cossup.org.

Thank you for your interest in the mentor initiative.

Applicant Information *This question is required.

First Name *This question is required.

Last Name *This question is required.

Job Title *This question is required.

Agency *This question is required.

Street Address *This question is required.

City *This question is required.

State *This question is required.

Zip code *This question is required.

Phone Number *This question is required.

Email Address *This question is required. This question requires a valid email address.

How did you learn about COSSUP’s TTA and Mentor Site Visit Initiative? *This question is required.

Please enter an 'other' value for this selection.

Does your local jail facility currently offer a MAT program (medication combined with counseling/behavioral therapies) for opioid use disorder prior to release? *This question is required.