New Castle County CISM Team - Team Members
Company Name - Company Message
CISM Team Member Form
 
 
The CISM Team relies on the valuable help and talents of dedicated volunteers to help us in our important work. Please fill out this online form if you are interested in volunteering with the CISM.  All information provided is kept confidential and will only be used for Crisis Response Activation.  The information is intended to be used only by the CISM Clinical Director and Team Coordinator.
 
 
Please complete and submit this form for Critical Incident Response.
Name
Home Address
Buisness Address
Home Phone
Business Phone
Cell Phone
Email
Station or Department Name
Station or Department Number (ie Station 1)
Company or Business Name
Profession or Occupation (Choose the one which best represents your role in CISM)
Number of years involved in CISM
Please check the CISM classes you have successfully completed.
Group Crisis Intervention
Advanced Group Crisis Intervention
Individual Crisis Intervention and Peer Support
Adv. Indiv. Crisis Intervention and Peer Support
Families and CISM
Corporate Crisis Response
Law Enforcement Perspectives for CISM
Line of Duty Death
Workplace Violence
Pastoral Crisis Intervention
Psychological First Aid
Suicide Prevention, Intervention, Postvention
Best Practices in Critical Incident Response
Other
Trained Trainer for the ICISF or CCN?
Are your available for Corporate Responses (ie banking industry, manufacturing)?
For Delaware Responders Only, please check the county for whom you respond or represent. All county members may be used if a crisis response is activated.
For Non-Delaware Responders, please provide your City, State, and County from where you will respond.
I have read, understood, and agree with the CISM Ethical Statement found in the Forms Section of the NCC CISM website.
I have read, understood, and agree with the Delaware CISM Law found in the Forms Section of the NCC CISM website.
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Thank you for completing this application form and for your interest in volunteering with us.
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