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First Responder Wellness Training Path

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First Responder Clinician
TRAINING PROGRAM APPLICATION

First name

Last name

Email

Phone

Licensure Type * Required

Licensed

Associate

Have you worked as a first responder? * Required

Yes

No

License Number:

If yes, explain:

First Responder Experience

Do you have any experience with first responders either professionally or personally? If so, what?

Why do you want to work with first responders?

Why did you choose your vocation?

Thanks for submitting!

Restoration Family Counseling Inc.

Network@RestorationFCC.com

The Restoration First Responder Network: First Responder Wellness Training Program is a professional development distinction awarded by Restoration First Responder Network. It is not a license, certification, or clinical credential. It does not authorize independent practice or imply regulatory authority. All clinical services must be provided within the scope of the provider’s professional license and supervision status, as governed by the Clinician’s respective State laws and Governing Licensure Board.

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First Responder Clinician TRAINING PROGRAM APPLICATION

First Responder Experience

First Responder Clinician
TRAINING PROGRAM APPLICATION