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CABLE CIT Coordinator Training

First Name (individual completing registration) *

Last Name (individual completing registration) *

Name of Agency/Organization *

Agency Address *

City *

State/Province *

Zip/Postal Code *

Work Phone *

Email Address *

Please provide the name of your department's training officer.

Please provide the email address of your department's training officer.

Please select which option best fits your department/agency. *

Well-established CIT program/coordinator position, interested in expanding knowledge base

Newly established CIT program/coordinator position, <2 years

No established CIT program/coordinator position, interested in learning where to start

Unsure Unsure

Does your department have a designated CIT Coordinator? *

Yes

No

Unsure/not applicable

If yes, please provide the name of the CIT coordinator.

Does your department have a formal CIT policy? *

Yes

No

Unsure

Does your department have an embedded clinician? *

Yes

No

Unsure

If yes, what is the clinician's name?

If yes, what is the embedded clinician's name?

Does your department have a peer support coordinator? *

Yes

No

Unsure

If yes, what is the name of the department's peer support coordinator?

First Name - Participant *

Last Name - Participant *

Participant Email Address *

Job Title/Position *

Rank (if applicable) *

POST-C ID

Which of the following best describes you (participant)? *

CIT coordinator for department

CIT trained officer

CIT trainer officer/interested in becoming department coordinator

Supervisor overseeing CIT program

Other Other

Add Another Participant

First Name - Participant *

Last Name - Participant *

Participant Email Address *

Job Title/Position *

Rank (if applicable) *

POST-C ID *

Which of the following best describes you (participant)? *

CIT coordinator for department

CIT trained officer

CIT trainer officer/interested in becoming department coordinator

Supervisor overseeing CIT program

Other Other