*1.Information(Required.)

Title

Full Name

Department

Email

Phone Number

*2.Level requested(Required.)

Level II

Confirmation

*3.I confirm my understanding that the online and practical portions of this curriculum are to be used in sequence. The use of the online portion is not appropriate or sufficient on its own.(Required.)

I confirm

I do not confirm

*4.I confirm my understanding that the material provided is intended as a curriculum to be developed and not a course to be given as presented, even though the online portion is presented as a course.(Required.)

I confirm

I do not confirm

*5.I confirm that my organization meets the criteria that are specified as required to develop and give a course in and deliver the course safely in my organization.(Required.)

I confirm

I do not confirm

*6.I confirm that my organization will assume all responsibility for the safe delivery of any course developed with this material and that CAFC will hold no responsibility(Required.)

I confirm

I do not confirm

*7.I confirm that my organization will provide a debrief on the use of the requested material within 1 year of receipt to the CAFC(Required.)

I confirm

I do not confirm