UFCI Urban First Responders Program

UFCI BIBLE COLLEGE 1WESTBROOK CORPORATE CENTER, WESTCHESTER, IL 60154

UFCI Urban First Responders

We are currently taking enrollments.

"You must attend 4 out of 5 sessions to qualify for limited stipends."

Please complete the form below:

Name*

First NameLast Name

Submit Current Date*

Date of Registration

Phone Number*

Area CodePhone Number

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you a resident of the Austin Community?*

YESNO

Please provide the following information.*

What do you know about Urban First Responders? You must select one of the three responses for each question:*

	1. Not knowledgeable	2. Somewhat Knowledgeable	3. Very Knowledgeable
1. Would you like to become an Urban First Responder?
2. Do you know how Urban First Responders work through the church and other community agencies?
3. Are you knowledgeable about how important it is to reduce crime in the community?
4. Are you familiar with continuity of care between hospitals and churches?
5. If you were a victim of violence, would you appreciate having an advocate from the church to assist you?
6. Do you know about the social services available in the area?
7. Are you aware of the impact your intervention would have on curtailing violence in the community?
8. Are you in need of any social services?

Our program is designed to address violence in our community questions. You must select one of the three responses for each question:*

	1. YES	2. NO	3. SOMEWHAT
1. Have you ever been a victim of violence?
Is education important to you?
2. Do you see a decline in economic opportunities in your community?
3. Are you concerned about the violence in your community?

We record our sessions time to time. You consent to being recorded during our sessions.*

YesNo

Provide the date you enrolled in the Workshop. The date must match the Workshop Schedule!*

Date

A certificate will be isssued upon completing the workshop.