NVMRC Overdose Prevention & Education Team

Are you interested in joining the Naugatuck Valley N.O.P.E. Team?

Please fill out this short survey and Unit Leader Jess will contact you.

*1.Contact Information(Required.)

First and Last Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

*2.Are you a current NVMRC Volunteer?(Required.)

Yes

Not Yet, Please Send Me an Application

I'm Not Sure

*3.Which of the following best describes your current occupation?(Required.)

Behavioral Health Professional

Dentist

Education

EMS Professional

Firefighter

Mental Health Professional

Non-Medical Professional

Nurse

Nurse Practitioner

Pharmacist

Physician

Physician Assistant

Police

Realtor

Retired

Social Worker

Veterinarian

Public Health

Other (please specify)

*4.Have you completed the following required online FEMA trainings?(Required.)

ICS-100.B: Introduction to Incident Command System

IS-700.A: National Incident Management System (NIMS) An Introduction

IS-200.B: ICS for Single Resources and Initial Action Incidents

None of the Above

*5.What is your level of interest?(Required.)

I'd like to participate in the train-the-trainer session so I can train more people in overdose recognition and prevention.

I'd like to volunteer at a health fair(s) to educate the community after I have completed training.

I'd like to help disseminate flyers and other information to the community.

I'd like to help recruit more NVMRC volunteers.

Other (please specify)

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