Human Services Information Request

* fields are required

Please fill out this form to get more information on our program options. Someone will reply within two business days.

First Name: *

Last Name: *

Phone: *

Email: *

Street Address:

City:

State:

Zip:

Course of study most interested in: *

Short-Term Certificate in Chemical DependencyAssociate of Applied Science degree in Human Services-Generalist trackAssociate of Applied Science degree in Human Services-Alcohol/Chemical Dependency trackUnsure

Time of Day most interested in taking classes (select all that apply): *

Morning
Afternoon
Evening

What semester do you hope to start: *

SummerFallSpring

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