Fillable High School To Post Secondary Education For At Risk Students Registration Form Marsack Topolewski2720 (Eastern Michigan University)

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High School To Post Secondary Education For At Risk Students Registration Form Marsack Topolewski2720 (Eastern Michigan University)

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Registration Form
High School to Post-Secondary Education for At-Risk Students
When: Friday, February 7, 2020
Time: 9:00am-4:00pm
Location: EMU Halle Library
955 W. Circle Drive, Ypsilanti, MI 48197
Name:__________________________________________________ DHHS Child Welfare Caseworker: Yes No
Employer:_______________________________________________ DHHS/DHHS-Contracted Private Child Welfare Agency Yes No
Address:__________________________________________________________________________________________________________
Email Address:_____________________________________________________________________________________________________
Phone Number:_________________________________________ Will you need Parking: Yes No
Cost applies if a non-DHHS Child Welfare Caseworker/Agency: $50.00 – Please indicate which method of payment you will be using below.
**Please note: Seating is limited
Method of Payment:
Check (Made Payable to: EMU School of Social Work)
Credit Card or Cash: Can be made at the door on the day of the event
This Child Welfare In-Service Training course has been approved by the Michigan Social Work Continuing Education Collaborative for 6 CE Hours.
This form can be downloaded and emailed to emu_socialworkce@emich.edu.
Or mail completed form with your check to:
Eastern Michigan University, School of Social Work, 319 Marshall, Ypsilanti, MI 48197
If you have any questions about registration, please contact Colleen O’Brien at 734.487.3758 or at emu_socialworkce@emich.edu
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High School To Post Secondary Education For At Risk Students Registration Form Marsack Topolewski2720 (Eastern Michigan University)

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Completed 22 July 2020

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