Please complete and submit this form for Critical Incident Response.
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)
SWAT Team member
Probation and Parole Officer
Mental Health Worker
Number of years involved in CISM
0 - 1 Years
1 - 5 Years
5 - 10 Years
10 + Years
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
Pastoral Crisis Intervention
Psychological First Aid
Suicide Prevention, Intervention, Postvention
Best Practices in Critical Incident Response
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.
New Castle County
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.