Interest Form: Classroom & Community Programs
Thank you for your interest in College Clinic!

Since 2004, College Clinic has helped more than 10,000 students and parents transition into college and beyond through academic preparedness, financial literacy, and basic life skills. We are dedicated to customizing a curriculum that
special for your students, parents, and counselors.

Please take a moment to complete our questionnaire to better assess the needs of your students.

We look forward in helping your students create a plan for what life and learning looks like after high school. To schedule your College Clinic After School Program, please call us at (404)500-8822 or email info@CollegeClinic.org.

Your Sister in Service,
Brandi Rae Hicks
Executive Director & CEO (College Encouragement Officer)
College Clinic
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Email *
Last Name *
First Name *
Name of School *
Grade Level(s) *
Number of Students in School or Grade Level *
Phone number *
E-mail *
Preferred contact method *
Required
Website
What type of program are are you seeking for your students? *
Required
Which courses are you interested in for your students? *
Required
Time of Program: Choose a timeframe *
Required
Time length *
Required
Are you interested in learning more about our College Clinic Speakers Series for 1st grade - 8th graders? *
What additional information would you like for College Clinic to know prior to our Student Ambassador Orientation appointment?
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