New York State Psychological Association

DRN Application

Disaster Resources Network Application

Chair: VACANT

NYSPA's Disaster Resource Network (DRN) is a community of NYSPA psychologists committed to humanitarian and clinical involvements during times of man-made and natural disasters.

NYSPA has many disaster and trauma experts and a long tradition of commitment to providing psychological support during times of disaster. Whether you are a former or new DRN member, we invite you to help us revitalize this tradition during these uncertain times. The DRN fosters collaboration, expert training, and inspirational community service among psychologists who are willing to share their expertise and skills with our members, other professionals, and the public. The DRN partners with the American Psychological Association's DRN, as well as with the American Red Cross, which is the national and regional agency that oversees, dispatches, and empowers mental health workers during experiences of disaster.

Please complete the information below to join the Disaster Resources Network.

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* Name and Address

Full Name and Degree *

Address Line 1 *

Address Line 2

City/Town *

State *

ZIP *

Email Address *

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* Phone Numbers (with area code)

Mobile Phone

Office Phone

Home Phone

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* County Information

County in which you live

County in which you work

Counties you would be willing to serve

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* Language Fluency (other than English)

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* License Information

NYS License #

Other States Licensed In

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* Please list the settings where you work (e.g., name of hospital, clinic, school, private practice, etc.)

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* Have you had disaster mental health training?

Yes

If yes, please provide dates, locations and providers of training (e.g., Red Cross, APA, NYSPA, Other)

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* Disaster Work You Have Participated In (please give date, location, and type of disaster, e.g., terrorist attack, earthquake, hurricane, plane crash, fire, school violence, community violence, etc., and list all that apply)

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* Areas of Expertise (please check all that apply)

Adolescent Treatment

Adult Trauma

Anger Management

Anxiety

Childhood Trauma

Crisis Management

Depression

Disaster Mental Health

Domestic Violence

Family Therapy

First Responders

Forensic Psychology

Grief and Bereavement

Media Psychology

Post Traumatic Stress Disorders (PTSD)

Rape

Relational Trauma

School Bullying

School Violence

Stress Management

Survivors of Trauma

Violence

Workplace Bullying

Workplace Violence

Other (please specify)

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* Would you be interested in giving talks in the following contexts? (please check all that apply)

Schools

Workplace Settings

Community Groups

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* Name and Address

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* Phone Numbers (with area code)

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* County Information

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* Language Fluency (other than English)

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* License Information

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* Please list the settings where you work (e.g., name of hospital, clinic, school, private practice, etc.)

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* Have you had disaster mental health training?

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* Disaster Work You Have Participated In (please give date, location, and type of disaster, e.g., terrorist attack, earthquake, hurricane, plane crash, fire, school violence, community violence, etc., and list all that apply)

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* Areas of Expertise (please check all that apply)

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* Would you be interested in giving talks in the following contexts? (please check all that apply)

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* Please tell us anything else you would like us to know about you