You must assist, facilitate, or complement the work of physicians or other specialists in the health care system. You must be certified, registered, or licensed by the state agency within the state where you provide this service. You must provide or supervise the provision of services to high-risk children and their families. High risk children are under the age of 21, are at risk of or have been abused or neglected, have serious emotional, mental, or behavioral disturbances, reside in placement outside the home, or are involved in the juvenile justice system. To qualify, individual must have been employed full-time in a local, state, or federal agency whose activities pertain to crime prevention.
Primary responsibility is crime prevention, control, reduction or enforcement of criminal law.
Activities include police efforts, criminal court jurisdiction, corrections, probation, or parole authorities. Agencies and positions whose primary responsibilities are civil, regulatory, administrative, or support are not eligible. To qualify, individual must have served active duty for twelve consecutive months in US Army, Navy, Air Force, Marine Corps or Coast Guard. Print form here. Print form here.