C.E.R.T. Volunteer Information Page

Lauri McMahon, P.I.E.R. Officer at I.M.F.D.

If you have any questions or concerns about this quiz,
please contact the creator of the quiz.

Hello, and thank you for taking the time to fill out this short questionaire about you and for showing your interest in our C.E.R.T. Program at Iona-McGregor Fire District. Please fill out every question. Your information will be kept strictly confidential and not shared with any outside organizations. To answer YES pick TRUE, to answer NO pick FALSE. We will be compiling the results and setting a date shortly for a informative meeting at the fire house where you can make a decision if you would like to be on the team or not. If you have any questions or would prefer to answer the following over the phone, please call Lauri at 425-9316. At the end of the questionaire, please put in your E-mail address if you have one. Thank you again and I look forward to meeting you soon! Lauri McMahon, P.I.E.R. Officer

What is your first and last name?

Your answer:

What is your address?

Your answer:

What is your phone number?

Your answer:

What community do you live in?

Your answer:

Are you a full-time, snowbird, 5/7 resident? Or what months do you live in the area?

Your answer:

What would be the best description of how you would like to help on the team?

Your answer:
Organizer/Team Leader
Clerical
Medical Rescue
It doesn't matter - where ever I can be used the most

Do you have any medical conditions that might limit the capacity in which you could help on the team? (Having a condition doesn't mean that you can't participate, it just gives us a better idea of where you can/can't help.)

Your answer:
TrueFalse

What would be the best day of the week for you to attend a training?

Your answer:

Are you able to attend a training once a week for 8 weeks?

Your answer:
Yes, I will plan to attend whenever you tell me the training is.
Yes, only if it was on the day and time I specified.
Yes, if I have advanced notice so I can clear my busy schedule.
I'm not sure.

Please list any medical, fire department, emergency response experience you may have. Please list how many years of experience, in what capacity, and the location.

Your answer:

Name:

Full email address:

Class:

NOTE TO THE STUDENT: If the answers are sent successfully, you will see another page come up in the web browser. If you don't see this page, it is possible that an error occurred during transfer and you should either resubmit your answers or notify your instructor.