Participation Confirmation for Eligible Indiana-Approved Agencies

Participation Confirmation for Funding Eligibility

This form is intended for Indiana-approved agencies that completed the survey in May 2023. Your agency is eligible to receive 50% funding towards the setup and a one-year subscription to the Handtevy Mobile platform.

Please complete this form by April 30, 2024, to confirm your participation. Per the EMS Division of the Indiana Department of Homeland Security, the commitment to procurement must be finalized by July 1, 2024. We invite you to confirm your commitment to these terms and secure funding for this essential resource.

First Name(Required)

Last Name(Required)

Department(Required)

Title(Required)

Email(Required)

Phone(Required)

Organization Name(Required)

Address(Required)

Procurement must take place by July 1, 2024. Is this something your department can commit to?(Required)

Procurement must take place by July 1, 2024. Is this something your department can commit to?

Yes

Earliest procurement date(Required)

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