Exercise Application (Non-Grant)

This Exercise Application should be completed for non-grant funded exercise requests. The application should take approximately 10 minutes to complete. There are six (6) sections in this application:
Items that will be helpful in completing this application are:
Please contact the Training & Exercise Unit (603) 271-2231 if you have any questions.

Section I: Applicant Information
Agency/Organization's Name:*
Agency/Organization's Address:*
Street Address Address Line 2 City State ZIP Code
Agency/Organization's Phone:*
Primary Contact's Name:*
First Last Title
Primary Contact's Phone*
Primary Contact's Email*
Alternate Contact's Name*
First Last Title
Alternate Contact's Phone*
Alternate Contact's Email*

Section III: Training & Exercise History
Have you previously conducted a similar exercise with or without HSEM?*
- Yes
- No
If so, were corrective actions from the previous exercise's After Action Report and/or Improvement Plan completed?*
- Yes
- No
What training have you done regarding this subject?*
Do you require any training prior to this exercise?*
- Yes
- No
What training do you require?*
Please explain how this exercise(s) will enhance emergency management capabilities.*

Section IV: Exercise Documentation
What plans, policies, and/or procedures do you want to test?*
Please include revision dates.
If possible please upload the relevant portions of your plans, policies and/or procedures here.
Drop files here or
Does this exercises fulfill any requirements for equipment purchased with federal funding i.e.: EMPG or HSGP?*
- Yes
- No
Please list the equipment purchased with federal funding.*
Will this exercise fulfill any accreditation or other requirement i.e.: CALEA, Clery Act, CMS requirements?*
- Yes
- No
If so, which one?*

Section V: Request for HSEM Support & Equipment
What resources do you require for this exercise?*
Select as many as applicable.
- Select All
- T&E Staff to write exercise
- T&E Staff to facilitate & conduct exercise (includes After Action Report)
- T&E Staff to evaluate exercise
- HSEM Equipment & Supplies
- Photography/Videography
- Controllers and/or Evaluators
- Volunteers
- Grant financing
Equipment Request Form
To request equipment from the Training & Exercise Unit to support your exercise, please complete the form linked here.

Section VI: Signature & Certification Page
Verification of Statements
The New Hampshire Department of Safety, Homeland Security & Emergency Management shall reserve the right to verify any statement or answer given on an application where good cause exists. Good cause shall include, but not be limited to the following:
1. A false statement or answer in an application; or
2. A change in the applicant's criteria which has not been reported on the application; or
3. Inconsistent or inaccurate statements in prior applications.
Signatures
True Statements*
By checking the box below, I certify that the statements in this application are true and correct to the best of my knowledge.
- I Understand and Agree
Name*
First Last Title
Today's Date*
Date Format: MM slash DD slash YYYY
Section Break

Section I: Applicant Information