CIT for EMS Course Interest Form
CIT for EMS Course February 9 - 13, 2026
Name
*
First Name
Last Name
Phone Number
*
E-mail Address
*
Station
Please Select
Rescue 01
Rescue 02
Rescue 04
Rescue 05
Rescue 06
Rescue 09
Rescue 13
Rescue 14
Rescue 16
Rescue 17
Resource Management
Marine Response
Support Services
Other
Certification Level
*
Please Select
EMT
AEMT
Intermediate
Paramedic
Other
Not Certified
Officer Code
Are you available to attend all 5 days of the CIT for EMS class?
*
Please Select
Yes
No
Not Sure
***Attendees MUST attend all 5 days of the class***
What interests you about the CIT program?
What knowledge, skills, and/or abilities are you hoping to gain from the CIT for EMS class?
Explain any experience you have working with persons with mental illness. This may be from EMS, family or friends, or professionally.
Explain any experience you have working with mental health support or outreach programs (such as peer support, domestic violence support, military, etc...)?
Have you previously attended a CIT/Crisis Intervention Training Course? If so, when and where did you receive your training? (Transcripts/Certificates may be requested.)
Submit
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