Applicant Name (Owner/Director) *
Center or School Name *
Position/Title *
Phone *
Email *
Street Address *
City *
State *
ZIP *
Type of Facility *
DaycarePreschoolPrivate SchoolCharter SchoolPublic SchoolCollege/University
Number of Staff Members You Plan to Certify *
Has your staff received formal emergency protocol training in the past? *
YesNo
If yes, when and what type:
Do you currently have an Emergency Operations Plan (EOP)? *
If yes, does it include: (Check all that apply)
Active Shooter ResponseCombative Parent ProtocolsShelter-in-Place ProceduresEmergency Lockdown Procedures
Tell us why your school, center, or staff should be considered for a certification grant: *