Thank you for your interest in the Community Based Crisis Intervention Training. Please complete the short registration form. For questions, please email 958Training@health.nyc.gov.

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* 1. Is this your first time attending the training or are you renewing your designation?

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* 2. First Name

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* 3. Last Name

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* 4. Email

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* 5. Provider Agency – if your agency is not listed, select ‘Other’ and enter your agency’s name.

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* 6. Program Type – if your program type is not listed, select ‘Other’ and enter your program’s type.

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* 7. Are you a physician or a qualified mental health professional?

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* 8. Verification of Employment (such as a copy of current employment ID)

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* 9. Verification Letter of Role on a Mobile Team (a letter on business letterhead with name and approval by supervisor)

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* 10. New York State Identification (for example, NYS drivers license, Enhanced or REAL ID)

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* 11. Verification of NYS Department of Education Registered License (such as a copy of current registration of license listed in the Office of Professions by the State Department of Education)

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