Stop the Bleed - School Course/Kit Request Data Tracking Form

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Data tracking and course request form required in rule for all Colorado public schools participating in the Stop the Bleed (STB) program through HB23-1213

Email *

Name of the school requesting STB course/kits *

Enter "School Code"/Unique Identifier (Found on CO Dept of Edu "All Colorado Schools" XLS). *

School full physical address *

School administrative contact's first & last name *

School administrative contact's email *

School administrative contact's phone number *

STB course/kits requester's first & last name *

STB course/kits requester's email *

STB course/kits requester's phone number *

Population of the SCHOOL enrollment requesting the STB course/kits *

0-500 students

501-999 students TIMES 20

1000 + students

Option for each school is about 400 or more

Are you currently working with a STB instructor? *

Yes - I am working with an instructor already

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