January 2026 ICISF Training Application: Rochelle, IL

January 2026 ICISF Training Application

4 Day training is a combination of ICISF's Individual Crisis Intervention and Group Crisis Intervention in Rochelle, IL, January 13-16.
The 100 Club of Illinois is excited to offer the ICISF Individual and Group Crisis Intervention 4 day training free of cost (for first responders) to promote the sustainability of department and first responder critical incident resources. This course has limited seats available and a participant application is required to be considered to attend. Course seats are being held for applicants who have a strong working knowledge of the first responder culture and who will be able to implement their training immdediately through critical incident call outs and/or peer support responses.

Inidividuals who submit their application by December 1 will be notified of admittance by December 19. All other applicants will be considered on a rolling basis. If seats are unavailable for all applicants, a waitlist will be created. You will be notified regarding your course admittance via email.

Please see the course flyer and website for details of the training. If you are unable to attend all four training days, please do not confirm your availability for the class as this will take away the opportunity for others to attend.

We ask that you complete the following application in full to help us get to know you, your (or your department) needs, and your goals with fulfilling this course. Some of the questions asked in this form are for attendee grant tracking purposes and will assist with training evaluation needs.

Please Note: Clinicians who are not directly affiliated with a department or who do not have the endorsement of a CISM team will be assessed the following registration fees:

$300 for the Individual Crisis Intervention course
$300 for the Group Crisis Intervention course
$500 for both courses (full 4-day training)

If you have any questions regarding the course, application, 100 Club, or your department programming needs, please contact Meg Krase at mkrase@100clubil.org.

Thank you!
Individual Information
Full Name*

First NameLast Name
Title*
Rank*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Are you currently:*

An active duty first responderRetired first responderCivilianOther
What line(s) of work do you serve in?*

Law Enforcement OfficerCorrections OfficerFirefighterParamedicDispatchCounseling/Social WorkOther
Your First Responder Wellness Role(s)*

Agency Wellness CoordinatorPeer SupportTherapy K9 HandlerCISM ResponderClinicianChaplainOther
Age:*

18-2526-3031-4041-5051-6061+Prefer not to answer
Race: (select all that apply)*

Hispanic, Latino, or Spanish origin of any raceAmerican Indian or Alaskan NativeAsianNative Hawaiian or other Pacific IslanderBlack or African AmericanWhite or CaucasianPrefer not to answer
Gender:*

MaleFemalePrefer not to answerPrefer to self-describe as:
Agency Information

Please provide information about the agency you work for
Agency Name*
Agency address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County agency is located in*
Agency Website*
Current Agency First Responder Wellness Programs*

EAPIn-house clinician or social workerIn-house chaplainTherapy K9Wellness spaces (quiet room, gym, etc.); please specify below in "other"On-duty wellness allowances (gym time, nap time, etc.); please specify below in "other"Annual mental wellness checksFamily programming or resourcesNone of the aboveOther
Critical Incident Stress Management (CISM) Teams

Some attendees have interest in joining an existing CISM team and/or others utilize this training to serve first responders through their departments. Help us understand how you plan to use this training as well as your previous experience with CISM teams (if any).
Have you participated in a response from a CISM team?*

YesNoI'm not sureOther
If so, please describe your experience: what went well and what you would have changed.
Do you plan on joining an existing Illinois Critical Incident Stress Management Team (if so, which one) and/or utilizing this training for internal department purposes? *
In your current role/agency, how large is the first responder population that you could potentially serve with the skills you gain from this training?*
Are you able to serve first responders in communities outside of your immediate department or county upon request?*

YesNoOther
Training Pre-Survey
How or who from did you hear about this training opportunity?*

Regarding serving first responder stress or critical incident needs, rate yourself in the following categories at this time:*

	Not Very	Somewhat Very	Very	Extremely Very
Ability to assess group needs
Ability to assess individual needs
Ability to advise on identified needs
Ability to implement strategic intervention planning
Knowledge of crisis intervention strategies: Critical Incident Stress Management, Critical Incident Stress Debriefing, Crisis Management Briefing
Confidence to implement crisis intervention strategies: Critical Incident Stress Management, Critical Incident Stress Debriefing, Crisis Management Briefing
Knowledge of psychological crisis
Knowledge of unique factors first responders face as it pertains to stress and crisis

Overall, how equipped do you currently feel to serve first resonders' critical incident and stress related needs:*

1

2

3

4

5

1 is Not Very, 5 is Very
How much do you know about the ICISF Training modules and resources?*

1

2

3

4

5

1 is Not Very Much, 5 is Very Much
How much do you know about the 100 Club of Illinois resources?*

1

2

3

4

5

1 is Not Very Much, 5 is Very Much
What do you hope to gain from this training?*
Training Commitment

Help us ensure seats are filled with available attendees
Are you available to attend all 4 days in-full of the training dates listed?*

YesNoOther
Are you able to provide your own transportation and lodging accommodations as needed (financially and time) to attend this training?*

YesNoOther
The 100 Club of Illinois is excited to offer this training free of cost (value up to $400) to promote the sustainability of department and first responder critical incident resources. Please ensure your availability to attend. If your availability changes by the time applications are reviewed, please indicate that at the time of your application acceptance in order to allow for others to be able to attend.*

I acknowledge this agreement and am currently available to attend. If my availability changes, I will be sure to notify the 100 Club at the time of acceptance.
Please leave any other comments or questions for us regarding the training, 100 Club of Illinois, or your agency needs:
Should be Empty:

January 2026 ICISF Training Application

Individual Information

Agency Information

Critical Incident Stress Management (CISM) Teams

Training Pre-Survey

Training Commitment