External ESC Region 11 Crisis Response Team Interest Form

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Thank you for your interest in joining the ESC Region 11 Crisis Response Team. Please fill out the following fields so we may get to know you a little better. Team members accepted will be notified no later than Friday December 18, 2020. Any questions regarding the CRT survey or participation may be directed to Sandy Benavidez at sbenavidez@esc11.net.

Local Education Agency (District, charter, or private school) *

Specific Campus Name *

Name (Last name, First name) *

Contact Phone Number *

Current Position *

Immediate Supervisor (Last name, First name) *

Do you have support from your immediate supervisor to participate on the CRT team? *

Yes

Will discuss once accepted to the team

Other:

Briefly describe your interest in joining the CRT team. *

Which of the following qualifications, certifications, or skill sets do you possess? (Check all that apply). *

School Counselor Certification

Licensed Professional Counselor

Mental Health Certification

Previous experience with grief or trauma

Bilingual (Spanish/English)

Strong desire to support students, staff, and the community in the areas of grief and trauma

Previous experience in school safety

NOVA Certified

Other:

Required

A 3-day crisis professional development training will be required for all participants. Are you available from 2/24/21 to 2/26/2021? *

Yes

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