School Mental Wellness Interest Form

Please answer the questions below.

Please note: * (asterisk) Indicates a required field.

Contact Information

Name:

First Name

Last Name

Address:

Mailing Address

City

State

Zip

Email/Phone:

Email Address

Phone Number

Current Position:

School Affiliation:

Which school are you affiliated with?

Privacy Policy:

The College of Continuing Education respects your right to privacy. Any information given to us when requesting course or program material will be used solely for the purpose of answering or responding to your request. We do not sell or otherwise distribute your personal information. We may, however, use it to provide you with advanced notices of our course offerings. If at any time you wish to be removed from our mailing lists, you may contact us and your request will be processed immediately.