Tier 2 – Public Safety Form

First name (required)

Middle name (required)

Last name (required)

Phone Number (required)

Email (required)

MRT Only - class date, actively teaching, where taught MRT, how long been training, where taught MRT, RTA’s trained:

In what capacity will you be a Tier 2 Resource? (required)

- LE/Fire/EMS ONLY – state, city, county, Agency Name, station hours of operations, direct number to personnel (duty phone)

-Crisis Intervention Skills – what skill (Hostage Negotiation, ASIST, Basic EMS other CIT), are you actively teaching or doing, where were you taught these skills:

Availability (Please check at least one)

If you have a resume or BiO Sketch that would assist us in understanding your qualifications and experience, please upload and attach

I Agree

This blog is for information only. It is not intended as a replacement for therapy. If you need additional help, please see a qualified therapist.