Intervention Interview Form Application
Complete this form to enroll for the Intervention Interview requirement
Email *
What is your full name? *
What is your mailing address? *
What is the best phone number to reach you? *
What is your Virginia Driver's license number or Social Security Number? *
What is your date of birth? *
By enrolling, I understand that missed sessions may only reschedule according to availability and that payment for Intervention Interview is NON-REFUNDABLE. I understand that there will be a $25.00 rescheduling fee if RAASAP is not notified at least 24 hours in advance of your absence. I understand that the rescheduling fee must be paid prior to being rescheduled.
By typing my name below I acknowledge that I have read and understand the policy above. I will also be sent a request for electronic signature to acknowledge this policy before being enrolled: *
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