Fill - Free fillable Alc Sub Abuse Couns Cert FA18-SU19 - Proposed Certificate Alcohol & Substance Abuse Counseling PDF form

ClintonCommunityCollegeAlc ohol&SubstanceAbuseCounselingCertificateGraduationApplication

RevisedFall2018

COMPLETIONTERM MAY:___ AUG:___ DEC:___ Year:______ C#:__________________

PRINTNAMEEXACTLY ASDIPLOMA SHOULDREAD:___________________________________________

MAILINGADDRESSTOSENDPRINTEDDIPLOMA:_____________________________________________

______________________________________________________________ APT._________________

CITY:________________________ STATE:____________ ZIPCODE:_________________________



PHONE:________________________________ EMAIL:_____________________________________

CEREMONY(CHECKONE):WILL____ORWILLNOTATTEND____

Willattendceremonyshortcredits(≤6cr.):____Willtransfercreditsbackfrom:__________________



Discipline Credit

Hours

CourseTitle Scheduled Transfer Crs.

Earned

HumanServices(30

Credits)



3 HUS101‐IntrotoHumanServices   

3 HUS105‐IntrotoBasicCounselingSkills 

3 HUS108‐FoundationsfortheChemical

DependencyProfessional



3 HUS110‐CriticalIssuesinChemicalDependency  

3 HUS175‐EthicsofChemicalDependency

Counseling



3 HUS201‐SocialServicesAgencies

3 HUS206‐GroupSkills

3 HUS210‐Identification,Diagnosing&Treatment

Planning



6 HUS284Internship&SeminarforCASAC 

Total 30   



StudentSignature:_____________________________________________Date:____________________

AdvisorSignature:_____________________________________________Date:___________________



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Alc Sub Abuse Couns Cert FA18-SU19 - Proposed Certificate Alcohol & Substance Abuse Counseling

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