All Certified Staff:

Please return this form to Mrs. Asher (high school) or Mr. Burgess (elementary) 
by Thursday, February 12.

Crisis Prevention Institute training for Nonviolent Crisis Intervention

Initial certification and refresher training for re-certification will be held in late March or April on either the high school or elementary campus.

Stipends will likely be $15 -  $20 an hour.

Staff Member: ___________________________Position: ______________________________

Please check all that apply to you:

•	Yes, I have been trained in Nonviolent Crisis Intervention at some time in the past.

	check one:
•	I would like to enroll in a 4 hour refresher course (amount of time since last training does not matter).
•	I would like to enroll in the complete program for a refresher (12 hours).
•	No, I do not wish to enroll in a refresher course at this time.

•	No, I have never been trained in Nonviolent Crisis Intervention.
		
	check one:
•	Yes, I would like to enroll in the 12 hour initial certification course .
•	No, I do not wish to enroll in the 12 hour initial certification course .

If you would like to take one of these courses please circle the choices that your prefer: 

Days of the week that you would prefer to take the course; Circle one or more:

Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	

Time of day that you would prefer classes; circle one or more:

4 hour refresher  course:		3:30 – 5:30	4:30 – 6:30 	5:30 – 7:30 	6:30 – 8:30   
(2 afternoon/evenings)	
				or Saturday  9:00 -1:00  	or Saturday 12:00 – 4:00

12 hour initial or complete program:	4:00 – 7:00 	5:00 – 8:00	6:00 – 9:00
(4 afternoon/evenings)
				or 2 Saturdays 9:00 – 4:00 (1 hour lunch)