Office of Chief Medical Examiner - Training Course Application

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Dear applicants, we are receiving a large number of applicants for the Basic and Advanced Courses in Medicolegal Investigation of Death. Each course will be offered several times over the next two years; if you are not accepted for the next class you may still be able to attend another.

Please Note: If you intend to apply for June 2010’s Advanced Course, you must submit your online application no later than January 29, 2010.

* - required fields.

* First Name:

MI:

* Last Name :

* Date of Birth (MM/DD/YEAR) :

* Email Address:

* Are you currently employed as a coroner, medical examiner, or medicolegal death investigator?
Yes No

Are you currently working in the field of Forensic Death Investigations?
Yes No

Please indicate your professional background or training. Select all that apply:
Law enforcement
Nurse practitioner
Nurse (RN, LCN, RCN)
Medical Examiner
Physician Assistant
Funeral Director
Lawyer
Forensic Anthropologist
Coroner
Medical Doctor
Other

Please indicate which section(s) you are applying for. Select all that apply:
Advanced Course: June 14-18, 2010
Basic Course: September 13-17, 2010
Advanced Course: December 13-17, 2010

Please describe how the knowledge and skills gained in this course can be directly applied to your job duties.
Be as specific as possible:

How will you share information from this course with your peers or colleagues?

How did you hear about OCME's Forensic Sciences Training Program?
Internet Search
AAFS Conference
Direct Mail (snail mail)
Direct E-mail
E-newsletter / E-journal
Print Ad
Word of Mouth
Other

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