CERT Registration Form

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Thank you for your interest in UCSB's CERT Program!

Please complete this form to register and secure your spot in the next 3 sessions. After submitting, a confirmation email will be sent to you. Directions to the EH&S Building will be included in this email.

All training sessions will be held from 9:00 AM - 4:00 PM in the Environmental Health & Safety Building.

The 3 sessions are scheduled for:

- April 28

- May 5

- May 11

Snacks, drinks, and lunch to be provided at all sessions!

If you wish to participate in CERT but cannot attend all of the dates above, please email sofiahernandez@ucsb.edu. Additionally, direct all other questions to sofiahernandez@ucsb.edu or jrcae@ucsb.edu.

Full Name *

Role at UCSB *

Undergraduate

Graduate

Faculty / Staff

UCSB Email *

PERM Number

Phone Number

How did you hear about CERT?

Class

Flyer

Other:

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Are you able to attend all 3 sessions?

- April 28

- May 5

- May 11

Yes

Maybe

Please enter any requests for food / drink

Submit

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