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CERT Volunteer Application

Apply to volunteer with the Clinton County Community Emergency Response Team.

Completing this application does not guarantee membership in the CERT program or a place in the next CERT Basic class. By submitting and signing this application, you give the Clinton County Emergency Management Agency (CCEMA) permission to verify all information stated on this application. Once your application has been received and reviewed, a representative from CCEMA will reach out with additional information regarding the membership process.

CERT Application

Required fields are marked with an asterisk (*).

Last Name *
First Name *

Address *
City *
State *
ZIP Code *

Phone *
Email *

Are you at least 16 years of age? *
If not at least 16 years of age, provide name and contact info for parent/guardian.
Have you completed the CERT Basic course? *
If you have completed the CERT Basic course, please indicate the year and jurisdiction in which you completed the course.
Current Employment Status
Do you have any previous volunteer experience?
Do you have any special skills, training, or experience which would be relevant to this volunteer program?
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Emergency Management

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Law Center

241 7th Ave N.
Clinton, IA 52732
Driving Directions

Mailing Address

P.O. Box 2957
Clinton, IA 52732

Contact Information

563-242-5712