C-CERT Online Registration Form

Campus Community Emergency Response Team (C-CERT)
Train-The-Trainer Program for American Colleges and Universities

Please note that required fields are denoted by an asterisk *.

* Select Training Location
Title (Sgt., Lt.,Cpo, Capt, D/C., Det, etc.) :
*First Name:
*Last Name:
*Email:
* Primary Occupation:
*Agency/Institution Name:
* Agency Address:
Address 2:
* City:
* State:
* Zip Code:
*Area Code and Agency Phone:
Area Code and Fax Number:
* How would you describe the type of academic institution you represent or serve:
*How did you learn about the C-CERT program:
* What Type of CERT training have you completed?:

This project is supported by Cooperative Agreement Number 2008-GT-T8-K010 administered by the
U.S. Department of Homeland Security. Points of view or opinions in this document
do not represent the official position or policies of the U.S. Department of Homeland Security.