CERT Backpack Request Form

The New Mexico Department of Homeland Security & Emergency Management (DHSEM) is committed to supporting Community Emergency Response Teams (CERT) across the state by providing essential gear to help volunteers stay prepared. Requests for backpacks may be made by government officials. An organization may make 1 request per calendar year. To ensure fair distribution, CERT backpacks will be prioritized as follows: 1. New CERT teams in communities without Homeland Security Grant Program (HSGP) or Emergency Management Performance Grant (EMPG) funding will receive first priority in the distribution of CERT backpacks. 2. Existing CERT teams in communities that do not receive HSGP or EMPG funding will receive second priority. 3. New CERT teams in communities that receive HSGP or EMPG funding will receive third priority. 4. Existing CERT teams in communities that receive HSGP or EMPG funding will receive fourth priority. For more information or to learn how to start a CERT team in your community, please contact your local emergency management office.

Name of jurisdiction CERT program operates in

Name(Required)

First Last

Phone(Required)

Email(Required)

Sponsoring Organization Name

Number of backpacks requested

Please enter a number from 1 to 20.

Is this a new or existing CERT?

New

Existing

Does the sponsoring organization receive HSGP or EMPG grant funding?

Yes

CERT Backpack Request Form

Address

Phone

Mailing Address

See Something, Say Something

Training Schedule