Fillable Alcohol Substance Abuse Counseling Certificate Form FA19-present

Fill Online, Printable, Fillable, Blank Alcohol Substance Abuse Counseling Certificate Form FA19-present Form

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Alcohol Substance Abuse Counseling Certificate Form FA19-present

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The Alcohol Substance Abuse Counseling Certificate Form FA19-present form is 1 page long and contains:

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  • 3 check-boxes
  • 33 other fields

Country of origin: US
File type: PDF

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Clinton Community College Alcohol & Substance Abuse Counseling Certificate Graduation Application
Effective Fall 2019
Completion Term
May: ___
Aug: ___
Dec: ___
Year: _________
ID#: 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 Attend ___ or Will Not Attend ___
Will attend ceremony short credits (≤ 6 cr.): ___ Will transfer credits back from: ______________________________
Discipline
Credit
Hours
Course Title
Scheduled
Credits
Earned
Human Services
(30 Credits)
3
HUS 101–Introduction to Human Services
3
HUS 105–Introduction 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 200–Case Management and Crisis Intervention
3
HUS 206–Group Skills
3
HUS 210–Identification, Diagnosing, and Treatment Planning
6
HUS 284–Internship and Seminar for CASAC
Total
30
Student Signature: _____________________________________________Date:____________________
Advisor Signature: _____________________________________________Date:____________________
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Alcohol Substance Abuse Counseling Certificate Form FA19-present

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Completed 9 February 2020

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