Brief Alcohol Screening and Intervention of College Students (BASICS) Training Registration

Please fill out the registration form below to attend our FREE BASCIS Training.
If you wish to receive Social Work or Mental Health Counseling CEUs please contact Kathleen Coletta at kcoletta@yesccc.org or 516-799-3203 x127 for payment. Fee for 10 CEU Credits: $100.00.

Location:
YES Community Counseling Center, 152 Center Lane, Levittown, NY 11756
Date/Time:

Tuesday, January 10, 2023 from 9:00 am – 3:30 pm
Wednesday, January 11, 2023 from 9:00 am – 3:30 pm

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* 1. Name:

First:

Last:

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* 2. Email:

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* 3. What agency, school or any other entity are you affiliated with:

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* 4. Job Title:

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* 5. Department:

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* 6. Do you need a FREE CASAC/CPP certificate?

Yes

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* 7. Would you like Social Work (SW) or Mental Health Counseling (MHC) CEUs for attending this training?

Yes

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* 8. If you answered yes to the above question, please provide the type of CEU credit needed and contact Kathleen Coletta at kcoletta@yesccc.org or 516-799-3203 X127

Social Work

Mental Health Counseling

Brief Alcohol Screening and Intervention of College Students (BASICS) Training Registration

Question Title

* 1. Name:

Question Title

* 2. Email:

Question Title

* 3. What agency, school or any other entity are you affiliated with:

Question Title

* 4. Job Title:

Question Title

* 5. Department:

Question Title

* 6. Do you need a FREE CASAC/CPP certificate?

Question Title

* 7. Would you like Social Work (SW) or Mental Health Counseling (MHC) CEUs for attending this training?

Question Title

* 8. If you answered yes to the above question, please provide the type of CEU credit needed and contact Kathleen Coletta at kcoletta@yesccc.org or 516-799-3203 X127

Question Title

* 9. Please provide license number for CEU credit: