Registration for CIT Basic (Core) Training Class

March 6-10, 2017 June 12-16, 2017 September 11-15, 2017

NAME:

AGENCY:

POSITION/TITLE:

ADDRESS:

WORK/CELL PHONE:

BEST EMAIL ADDRESS:

SSN OR OPERATOR’S # FOR DCJS

(Required for Virginia Department of Criminal Justice Services documentation)

The CIT Training will be held at the South Street Conference Center located at 124 North South Street Farmville, VA

23901. Training will begin at 8:00AM and end at 5:00PM each day with an hour for lunch. On Tuesday of each

training week the training participants will visit a number of mental health and substance abuse treatment facilities.

Transportation for these visits will be provided.

On Friday afternoon of each training week there will be a graduation ceremony. Each law enforcement officer will

receive a 40-Hour Department of Criminal Justice Services (DCJS) PIC Course Approval (including 4 hours legal training

& 2 hours Cultural Diversity). All participants will receive:

1.) A CIT Pin (designed to be worn on your uniform)

2.) A CIT Shirt - Check your size: Small Medium Large X-Large XX Large XXX Large

Do you need a: Tall Size Other, Please Explain______________________________________________

3.) A certificate verifying completion of the 40-hour CIT Training, in the name below:

(Your name as you would like it to appear on your CIT certificate)

Please Return EARLY FOR BEST CHANCE TO ENROLL

fax or e-mail to: Chris Riviere, CIT Coordinator

Phone: 434-392-3187 Fax : (434) 392-5789 E-mail: criviere@crossroadscsb.org 214 Bush River Dr, Farmville, VA 23901

NOTE: Confirmation of registration (including directions and course materials) will be e-mailed to each participant a

few days before the training starts. Make sure the e-mail address you provided above will reach you.

Heartland Crisis Intervention Team Crossroads Community Services Board

CIT Coordinator’s Office