Instructions for completing NCI Training Agreement
- The purpose of this document is to ensure that agencies providing services have measures in place to protect
clients and staff from injury when providing care or dealing with aggressive behaviors
- This form must be comepleted by each agency wishing to receive NCI Training
- Please have agency CEO (or the local person in charge if CEO unavailable) compelte the form by initialing each statement
- Some items in the top section may not apply to all agencies, so if one doesn't apply to you, please write "no touch" on the line
indicating that your agency does not allow holds or carries
- All agencies must initial the items in the bottom section
- Have document notarized and return to us via fax 336-855-3363 or mail in 4249 Piedmont Pkwy, Ste 103, Greensboro, NC 27410
Attn: Training Department
- This form must be returned before NCI Prevention certficates can be released and/or before staff can attend Core and
Core+ classes
- If we do not have a form for your agency please download via the link below. If you're unsure please call Barrett Carraway, Training
Director at 336-259-4113 for verification or if you have any questions regarding the form