Autism Awareness Training for First Responders

Please fill out the form below if you plan to attend.

Date: April 20, 2018
Time: 9:00am - 2:00pm
Where: Department of Emergency Response, 392 Creek Road, Room 113, Poughkeepsie

* = Required Field

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* 1. Name

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* 2. Address

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* 3. Title

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* 4. Email

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* 5. Phone

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* 6. Email*

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* 7. Telephone Number

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* 8. Names and titles of other staff attending from your agency (up to 3):

Attendee 1

Attendee 2

Attendee 3

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* 9. Please indicate service you provide (all that apply):

Fire Department (Volunteer)

Fire Department (Paid)

Fire Department (Other)

Law Enforcement (State)

Law Enforcement (Town)

Law Enforcement (Village)

Law Enforcement (City)

Law Enforcement (County)

Law Enforcement (State)

EMT (Volunteer/Fire Department)

EMT (Volunteer)

EMT (Paid)

Hospital Emergency Room Staff

Community Based Critical Care

Security Department

Other (please specify)

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* 10. If you answered "Security Department" in question number 9, please specify the following:

Agency Name

Parks Name

Organization

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* 11. Sign Language interpreter (Seven days notice is required to secure this service).

Yes

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* 12. Reasonable Accommodation needed (please specify)

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* 13. I would like to receive email notifications from Dutchess County ThinkDIFFERENTLY

Yes

No thanks