Apply for St. Helens CERT Program

Apply to volunteer for the St. Helens CERT program only.

Last Name: *

First Name: *

Middle: *

Address: *

Home Phone: *

Work Phone: *

Your GPA, for persons under 18 who are applying for the Teen CERT program only.: *

Date of Birth: *

Email Address: *

Drivers License #: *

Emergency Contact: Name: *

Emergency Contact Telephone: *

How did you hear about the CERT program?: *

Why do you want to attend?: *

Upon successful completion of the CERT Training curriculum, would you be willing to volunteer in future CERT events and Training?: *

Yes

No

Are you currently involved in any community or civic organizations? Please explain:: *

Criminal History: Have you ever been convicted of a crime? If yes, please explain below: *

Yes

No

Please Explain:

Agree to Background Check: *

Yes

No

I understand that the St. Helens Police Department will conduct a criminal background check on me, and that information revealed during that investigation may cause me to be excluded from the class.

Theme by Dr. Radut.

Apply for St. Helens CERT Program

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