Officer Certification Form

DARE Officer Certification Form

DARE Officer Certification 2017-2018 School Year 

                                                                                  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.


Phone; 262-623-0121

Jeff Smith

Wisconsin DARE Coordinator
1969 W Mill Rd
Jackson, WI 53037