Interest Form for Addiction Counselor Exam Preparation Course

After you submit the form, a CI representative will be in contact with you within one business day.

First Name
Middle Name
Last Name
Email Address
Re-enter email address
Main Telephone Number
Street Address
City
State
Zip Code
Check this box if you are age 18 or over?
What certification exam are you studying for?
Check this box if you have you submitted the application and been approved to take the exam
When do want to take the written exam?
Do you qualify to take oral exam once you pass the written exam?
Questions/Comments

 

 
   
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