EMS-C Tennessee Sensory Kit Application
Name of EMS Agency
Name of Primary Contact
First Name
Last Name
Phone Number of Primary Contact
Please enter a valid phone number.
Format: (000) 000-0000.
Email of Primary Contact
example@example.com
Address of EMS Agency
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you agree to participate in quarterly surveys to determine the effectiveness of the sensory kit?
Yes
No
Per grant requirements, participation in a virtual 90 minute IDD/Mental Health & Crisis training through the TNSTART program is required. Do you agree to participate?
Yes
No
Provide 3 dates/times (Mon-Fri) that work for your staff to participate in the virtual crisis training in 2025.
Submit
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