STRIVE III Orientation

If you have difficulty completing this registration, please contact the STRIVE Team by email at: STRIVE@dcjs.ny.gov.

Confirmation notices with additional information be e-mailed approximately 2 weeks prior to the Orientation. 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

Title/Rank *This question is required.

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)

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, Community Service Agency, etc):

Employment Status *This question is required.

3. Supervisory Approval *This question is required.

First Name

Last Name

Title

E-mail Address

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