Spring 2020 Training Information Form

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spring 2020 training: pre-registration/information form

Please note: The Form below with your contact information must be submitted by March 1 to guarantee a space in the Feb 18 and June 5-7 training events. This is NOT a registration form, however we need to know how many participants are interested in the events and their level of training in order to notify instructors of approximate numbers and determine whether we can offer both training classes at no or low cost.

Note that many of the questions have a red * next to them and must be answered in order for the submission to go through.

If you are not able to access the form please contact Susan at susan.grammer@okstate.edu.

Spring 2020 training interest statement/information request form

* Indicates required field

I am a (choose from drop down menu): *

Please choose the option closest to your situation. You will be able to explain your interest further if desired later.

If you selected "other" please tell us why you are interested in learning about training with PCART. *

Contact Information

Name (First, Last) *

First

Last

Email Address: *

Please list the email address that you check most often. This is the method we will use to contact you about these training opportunities.

Which County do you live in? *

Which County do you work in? *

Telephone number: Preferably with text availability *

We do not expect to call you at this point, however we would like to have your telephone number on file.

Is this a home, work, or cell phone number? *

I am interested in learning more about: *

April 18, 2020 Large Animal Handling During Emergencies Training June 5-7, 2020: Flood/Slack Water Animal Response Training

Please check both boxes if you think you are interested in both trainings. Space will be limited so those who express interest now will receive first consideration.

April 18. 2020: Large Animal Handling during Emergencies Training - I am: (Choose one) *

Definitely interested and available Possibly interested and available Just looking for information

Please explain why you are interested in learning more about how to handle large animals/livestock during a disaster or other emergency. *

June 5-7, 2020: Flood/Slack Water Animal Emergency Response Training:Choose One *

I am definitely interested in attending if there is no charge for this training I am definitely interested in attending if there is a small charge for tuition for this class (under $100) I am definitely interested in attending and my employer would cover the cost of this course from $100 - $500 I am considering registering for this class as long as it is free I am considering registering for this class as long as the fee is under $100 I am considering registering for this class and could pay tuition between $100 & $500 I am just looking for information for the future

Please choose a response closest to your situation. You will have the opportunity to provide additional information once we contact you. We do have grant funding for up to 20 participants but might be able to offer the class to additional participants if we charge a small fee.

Additional information related to June 5-7 Flood/Slack Water Training: *

I am a strong swimmer. I do not swim but am interested in learning about how I can help during flooding emergencies. I am able to attend all 3 days of training. I am NOT able to attend all 3 days of training. I am an OKMRC credentialed volunteer OR a credentialed first responder. I am NOT an OKMRC credential volunteer but am interested in becoming one before June 2020. I am NOT an OKMRC credentialed volunteer and am not interested in becoming one.

What type of animal experience do you have? Please check all that apply. *

Veterinarian Vet Tech Worked in Veterinary practice Groomer (Dogs &/or Cats) Groomer (Horses) Basic Animal Response Training Pet Sitting Pet Boarding Kennel Animal Rescue (Large Animal) Animal Rescue (Small Animal) Farm Animals (Cows, Sheep, goats, etc.) Horse care Horse Trainer Animal Breeding Dog Obedience/Training Dog Agility Training Therapy Dog Training Dog or Cat Shows Exotic Animal Experience (small mammals; rabbits, guinea pigs, etc.; Reptiles; Birds Emergency Services (Animals) Pet Owner Animal Transport (horse, large animal/livestock trailers) Riding Instructor Horse Owner Cattle Owner Other (please explain)

Experience directly with animals is not required. We have many tasks that do not require experience handling animals however we like to know what experience our volunteers have.

Please explain *

Have you deployed as animal responder? *

Yes No

What was the emergency and what role did you play? *

Emergency Services Experience *

Fire Service Emergency Medical Services Police Department Search and Rescue Other None

Please explain (if you checked "other") *

Please check boxes for training you have completed. You are not expected to have completed these courses but it will help instructors to determine level of previous training. *

OKMRC Orientation Family Preparedness Plan Psychological First Aid FEMA IS-100 Intro to Incident Command System (ICS) FEMA IS-200.b ICS for Single Resources and Initial Response FEMA IS-300 Intermediate ICS for Expanding Incidents FEMA IS-400 Advanced ICS Command and General Staff-Complex Incidents FEMA IS-005.a Introduction to Hazardous Materials FEMA IS-700 National Incident Management System (NIMS) FEMA IS-800 National Response Framework FEMA IS-000010 Animals in Disaster: Awareness and Preparedness FEMA IS-11a: Animals in Disaster: Community Planning FEMA IS-111a - Livestock in Disasters Animal Technical Rescue - Awareness Level Animal Technical Rescue - Operations Level/TLAER Animal Technical Rescue - Technician Level/TLAER ASPCA Pro Webinar: How to Respond to Tornadoes ASPCA Pro Webinar: How to Respond to Wildfires ASPCA Pro Webinar: How to Respond to Hurricanes FEMA Public Information Officer training FEMA IS-244.b Developing and Managing Volunteers FEMA IS-120 Exercise Design and Development FEMA IS-130 Exercise Evaluation FEMA VTTX-V00001: Livestock Evacuation Virtual Tabletop Exercise Earth Wind and Fire Other training (please list below) Webinar: Superstorm Sandy Animal & Agricultural Response: Lessons CPR/AED/First Aid Until Help Arrives CERT - Community Emergency Response Team

If you have additional FEMA, OKMRC, ASPCA, BART, DART, TLAER or other training please list this below. In addition, if you are a credentialed first responder, a riding instructor, or have other credentials please list them. *

Would you like to be added to PCART's email list for upcoming meetings, events, and training opportunities? *

Yes No

Is there anything else you would like to share with us about your reason for being interested in training with PCART and/or your availability? *

Submit Form to Request Information on Spring 2020 PCART Training