DARE Officer Certification Form
DARE Officer Certification 2017-2018 School Year
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In accordance with DARE America and DARE Wisconsin Policy.
A D.A.R.E. Instructor shall teach a series of a component of a D.A.R.E. curricula at least once in a 24-month period from the time the officer completed his/her last D.A.R.E. teaching assignment.
In order to maintain certification, Please complete the following information. This information is for the 2015-2016 school year. If you have already taught, are planning on or might teach this school year please include that information. If you are placed on special assignment that would preclude you from being able to teach, advise us of the situation.
Name Rank Agency
E-mail Phone
School District(s) Cities/Towns
Years You have taught DARE Number of Schools Taught in
Number of 5th/6th Grade Classes Taught Number of Students
Number of K-4 Classes Taught Number of Students
Number of Middle School Classes Taught Number of Students
Number of Community Programs Offered Number of Attendees
In the case where an Officer does not teach in a two year period written notification will be sent to the Officer as well as to the Chief or Sheriff advising them of their decertification. As well as steps required to regain certification.
Feel free to contact me with any questions you may have.
Email; jsmith@darewisconsin.org
Phone; 262-623-0121
Jeff Smith
Wisconsin DARE Coordinator
1969 W Mill Rd
Jackson, WI 53037