BASICS/CASICS Request Form
Please fill out the following form in order for us to match you with an instructor. Once this has been complete, an instructor will reach out to you and schedule your two part session.
Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
Were you assigned this course or referred? *
Which course do you need to take? *
Does your assignment letter say that this session needs to be conducted by a counselor? *
Please list all days and times that you would be available to meet with an instructor (Monday-Friday only) *
Your answer
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