To Become a Provider

FIRST Responder Support Team

To Become a Provider

To Become a Provider:

To apply to become a provider for the First and Intensive Responder Support Team network of counseling professionals joined to provide police officers low-cost and confidential counseling assistance, please fill out the form below, and you will be contacted by the Executive Director of the FIRST program regarding credentialing.

Contact information:

First name:

Last name:

Email address:

Phone Number:

Mailing address:

Provider Area/Specialty

Explain Provider Specialty & Experience with Emergency Responders:

Best way to contact you: