Danger Assessment Training with Dr. Jacquelyn Campbell

If you have difficulty completing this registration, please contact Helen Sorrento via email at: helen.sorrento@dcjs.ny.gov.

Completion of this registration DOES NOT guarantee you a seat in the class. Confirmation notices will be e-mailed approximately 2 weeks prior to the class. Please remember to check your junk/spam folder.

*Pursuant to NYS Personal Privacy Protection Law, DCJS is authorized to collect personal identifying information as part of a public safety agency record. Personal identifying information on this form shall not be revealed, released, transferred, disseminated or otherwise communicated orally, in writing, or by electronic means other than to the registrant. Disclosure of personal identifying information is voluntary. Refusal to provide personal identifying information shall not result in the denial of any right, benefit or privilege.

2. Attendee *This question is required.

Title/Rank

Last Name *This question is required.

First Name *This question is required.

Birthdate (Please enter as MM/DD/YYYY) *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Person ID: (Please enter in the following format: Last Name-DOB-Last 4 of SSN)
Example: Smith-01011999-1234 (no hashtags please) *This question is required.

Agency Name
Please begin typing agency name for ease of navigation of the list below. If your agency is not listed, please scroll to the bottom of the list and select "Agency Not Listed" and enter agency name and address in the fields that will appear below. *This question is required.

Agency Name and Address if not listed above *This question is required.

Agency Street Address *This question is required.

Address 2

City *This question is required.

State *This question is required.

Zip *This question is required.

Attendee E-mail Address *This question is required. This question requires a valid email address.

Phone Number *This question is required.

Position *This question is required.

If you are a peace officer, please indicate the type (i.e. Probation, Corrections, Parole, etc):

If you are a civilian, please indicate your job title (i.e. Investigator, Forensic Accountant, Advocate etc.):

Employment Status *This question is required.

3. Are you with a STRIVE-funded agency? *This question is required.

4. Are you planning on taking the post-certification test online in order to administer the full Danger Assessment? *This question is required.

5. Are you looking to become a certified "In-House Trainer" as part of your attendance? **Please note, this option is ONLY available to community-based DV Service Provider Agencies, who may identify 1-2 individuals to become in-house trainers.** *This question is required.

In-House Trainers will be victim advocates, domestic violence advocates, or other individuals who provide direct services to individuals who experience violence. Do you currently serve in one of these direct service roles within your agency? *This question is required.

You do not currently meet the In-House Trainer criteria, but you are still welcome to attend the training.

Please provide the following information: *This question is required.

Organization Name

6. Supervisory Approval *This question is required.

First Name

Last Name

Title

E-mail Address

7. Attendance Confirmation (E-Mail address) *This question is required. This question requires a valid email address.

Training Certificates
Certificates of completion for any DCJS hosted training event will be available for download for any police or peace officer listed on the NYS Police/Peace Officer Registry through the DCJS Acadis Portal. Please contact your agency Acadis Point of Contact to access and download your certificate.

Civilian attendees may request a copy of their certificate by contacting DCJS at email listed below.

Any questions or assistance regarding obtaining a DCJS hosted course certificate may be directed to ops.generalpolicing@dcjs.ny.gov.