Interest Form for Certified Prevention Specialist

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

First Name
Last Name
Email Address
Retype email address
Main telephone number
Street Address
City
State
Zip Code
Why do you want to become a Certified Prevention Specialist?
Describe your experience, if any, in the field substance abuse counseling or helping others.
Use this space for your questions and/or comments
Check if 18 or over

 

 
   
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