CCC&TI Human Services Technology Information Session Confirmation

Please check the appropriate boxes:

I certify that I have viewed and understand the online presentation of information for the Human Services Technology program at Caldwell Community College & Technical Institute.

I still have questions that were not answered in the presentation. I will contact Student Services or the Program Director for assistance.

I understand that in order to complete the Information Session admission requirement that I must submit this form to Student Services immediately. The date that this form is received by CCC&TI will be used to meet this requirement in my admission folder.

Please check which program you plan to complete at this time:

Associate Degree in Human Services Technology (Mental Health)

Diploma in Human Services Technology

Certificate in Human Services Technology

I have made a copy of this confirmation for my personal records.

Please read the Technical Standards document before completing this section.

Declaration:
I have read and understand the technical standards required for Human Services Technology, I hereby declare that:

I am/the student is able to meet the above listed essential technical standards

I am/the student is unable to meet the above listed essential technical standards based on the following:
(please list standard that cannot be met and give rationale:)