Bay Minette, AL June 9, 2025 Refresher

Registration Form - Bay Minette, AL June 9, 2025

Fill out the form carefully for registration
Name*

First NameLast Name
E-mail Address*
Personal Phone Number*
Have you completed the 32-hour peer support training?*
Agency*
Are you an active 911 dispatcher?*
Enter either (y or n)
Are you an active, retired sworn peace officer, EMA Officer, or Dispatcher?*
Select position
How many years?*
Example: 10
Are you a Chaplain attached to a law enforcement agency?*
Enter either (y or n)
Who appointed/hired you?*
Are you a licensed mental health professional?*
Enter either (y or n)
Please provide your certification level, license #, three references (preferably law enforcement), and a brief biography along with why you want to work with law enforcement.*
This ALLEAPS course is restricted to Law Enforcement Officers, EMA Officers, 911 Dispatchers, Chaplains, and Licensed Mental Health professionals.

You do not meet the minimum requirements for this course.
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Registration Form - Bay Minette, AL June 9, 2025