Prevention Services Request Form
Hafa Adai yan Tirow,

Please use this form to request services from the Substance Abuse Prevention Services Unit. Please fill in the information below that is applicable to your request. All requests must be submitted no less than two (2) weeks in advance, but preferably four (4) weeks prior to the service request date(s) due to planning and staff availability.

NOTE: ALL PREVENTION SERVICES REQUEST ARE SUBJECT TO APPROVAL.

If you should have a hard copy of our Prevention Services Request Form, you may deliver the form to the Community Guidance Center Main Office located at the TSL Plaza, 2nd Flr. during business hours (Mon - Fri , 7:30 AM - 4:30 PM) or via email prevention.cgc@gmail.com

CANCELLATION/CHANGE:
Should there be any cancellation or rescheduling needed after the request has been submitted, we require that immediate notification be made via phone at 323-6560/61 or via email prevention.cgc@gmail.com


Thank you,
CGC - Substance Abuse Prevention Services Unit



Requester's Name *
Your answer
Contact Number: *
Your answer
Name of Organization/Agency *
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy