CISM Team Member Application

Want to be part of the team?

Individual Crisis Intervention and Peer Support (ICISF) certification class is the foundation for all other CISM training. It is designed with the first responder in mind. You do not need to have prior training. This is the minimum training required to be an active member of the CSEMS CISM team. See our training page for course offerings.

CISM Team Member Application Form

CISM Team Member Application Form

First Name *

Last Name *

Address *

E-mail Address *

Home Phone Number *

Cell Phone Number *

Current certification or licensure, if applicable.

Emergency Medical Responder

Emergency Medical Technician

Advanced EMT

Intermediate

Paramedic

Nurse

Doctor of Medicine (MD)

Doctor of Osteopathy (DO)

Please attach a scanned copy of your credentials and/or certificates to be considered with this application.

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Type of Instructor Course You Are Interested In

Please select one of more courses. *

Mental Health

Peer

OtherOther

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Disclaimer: All information on this application is confidential.

If you have questions or comments, please enter them below.

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