This page serves as your formal application to the Safety and Emergency Planning for Schools, Homeland Security Information Sharing Network (HSIN) Community of Interest (COI). This HSIN COI is designed for school safety practitioners to collaborate and share information in a private, secure space. As such, specific requirements for membership have been developed.

Information provided in this application will solely be used to review and vet your application against those requirements. Please be sure that responses are truthful and accurate as errors or discrepancies may lead to a delay in the application process. 

Thank you in advance for your interest in this COI. 

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* 1. First Name

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* 2. Last Name

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* 3. Professional Email Address

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* 4. Phone Number

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* 5. Organization/Professional Affiliation  

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* 6. Organizational Role

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* 7. Please provide a brief description of your school safety role and why you are requesting access to the Safety and Emergency Planning for Schools COI.

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* 8. Supervisor's First Name

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* 9. Supervisor's Last Name

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* 10. Supervisor's Professional Email Address

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* 11. Supervisor's Phone Number 

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* 12. Supervisor's Organization/Professional Affiliation

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* 13. By checking this box, you are confirming that the information provided in this application is honest and accurate. Furthermore, you are acknowledging that you currently serve in a position with direct school safety duties and responsibilities.

Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why DHS is requesting the information on this form.
Authority:  5 U.S.C. 301; 44 U.S.C. 3101.
Purpose: DHS is requesting this information in order to process, review, and verify an application for access to the Safety and Emergency Planning for Schools, Homeland Security Information Network (HSIN) Community of Interest (COI). This Survey Monkey application was provided either through direct email or through the “Information Sharing Community” link.
Routine Uses: The information requested on this form may be shared externally as a “routine use” with other named contributors to this interagency website (DHS, DOJ, ED & HHS) to assist DHS in providing instructions for accessing the secure HSIN COI through the use of the “Information Sharing Community” link. A complete list of the routine uses can be found in the system of records notice associated with this form, “DHS/ALL-002 DHS Mailing and Other Lists System.” The Department’s full list of system of records notices can be found on the Department's website at http://www.dhs.gov/system-records-notices-sorns.
 Disclosure: Providing basic contact information is strictly voluntary. However, failure to provide this information may result in being denied access to the Safety and Emergency Planning for Schools HSIN COI.

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