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Child Passenger Safety Technician Interest Form
Are you interested in becoming certified as a CPST in Nebraska? Fill out this form to help us determine future class needs.
Name
First
Last
Email
Phone
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City of Residence
County of Residence
I would be willing to take a class in one or more of the following regions of Nebraska (please check all you would be willing to attend):
Omaha
Lincoln
Tri-Cities (Kearney, Hastings, GI)
West-Central (Ogallala/North Platte)
Panhandle (Scottsbluff/Sidney)
Norfolk
Other (Please note in comments below)
Other choice of location:
I would be attending class in the following manner:
Paid by my employer to attend
Vounteering my time to attend
Unknown or mix of the above
I would be paying for the class in the following manner:
My employer will pay
I will pay or seek scholarships
Unknown at this time
