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EQUAL OPPORTUNITY STATEMENT
The Town of Rocky Hill, Connecticut does not discriminate on the basis of age, sex, race, color, religious belief, national origin, or disability in their admission.
PRIVACY ACT STATEMENT
General – This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 31, 1974, for individuals applying for admission to the Rocky Hill CERT Program.
Authority – 5 U.S.C.301; 15 U.S.C. 2206; 44 U.S.C. 3101; 50U.S.C. App. 2253 and 2281; E.O. 12127, 12148 and 9397; Title VI of the Civil Rights Act of 1964; and section 504 of the Rehabilitation Act of 1973
Purpose – To determine eligibility for participation in the Rocky Hill CERT program.
Uses – Information may be released to Federal Emergency Management Agency (FEMA) staff to analyze application and enrollment patterns for specific courses and to respond to student inquiries; and to a physician to provide medical assistance to CERT members who become ill or are injured during courses or operations.
Effects of Nondisclosure – Personal information is provided on a volunteer basis. Failure to provide information on this form, however, may result in a delay in processing your application and / or certifying completion of the program.
(All information is kept confidential)
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