Non-violent Crisis Intervention Program Training Request Form

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NON-VIOLENT CRISIS INTERVENTION PROGRAM (NVCIP) TRAINING REQUEST
Mark (X) one
2-day NVCIP training; (2) 6-hr days. Best Practice – Includes Prevention
Techniques, Verbal Intervention, Safety Techniques and Therapeutic Physical
Intervention. Certificate awarded following successful completion of
program. Lunch/breaks require additional time.
Same training format: (2) 6-hr days (instruction) as above, Autism Specific
Full day NVCIP training (8 hours of instruction.) Lunch/breaks require
additional time in schedule. Certificate awarded following successful
completion of program.
Same training format as above: (8 hours of instruction), Autism Specific
Verbal Intervention instruction only (6 hours instruction)
Refresher (minimum 3.5 hours,
breaks are additional time) Focus
Date(s) requested:
Certificate awarded
following successful
completion of program.
Start time:
End time:
Location: (requires participant tables/desks, chairs and open space)
District:
Bldg:
Room:
Requesting space at IU Doylestown Building
No. of participants:
(District should advise participants to dress casually, in
comfortable, but closed-toed shoes. Sneakers are suggested.) Maximum number is 35.
Manuals:
District requesting to be invoiced for each participant’s manual
Cost per manual is approximately $12.00
Act 48:
District will process Act 48.
Act 48 not required.
Requesting IU to process Act 48. Requires online registration.
Tel:
District Contact:
Email:
Return to Lois Gretzinger* [email protected]
Fax:
215-340-1639
*If your IU Program and Training Specialist or IU Behavior Analyst is a CPI Certified Instructor, email this
complete form directly to them and cc Lois if using IDEA funds for manuals. Other districts should email this
form to Lois to request the training.
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IU INSTRUCTOR NOTES:
Manuals available
DVD
2/13/16 Rev.
Overhead projector
Envelopes for participants to address/ Pens
Room Reserved
VCR
Epson
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