School Enrollment Application

TARP, Inc. provides classroom instruction in four locations - New York City (Manhattan and the Bronx), Glen Cove, Long Island, and Buffalo, New York to become a Credentialed Alcoholism and Substance Abuse Counselor (CASAC).

If you'd like to attend our classes, please complete and submit the application below. After we've reviewed your application, we'll contact you and, if approved, discuss payment arrangements.

For additional information, please see our Classroom Instruction page and/or download our 2-page School Announcement flyer (.pdf, 96 KB).

Please fill out your application completely and ensure your contact number is correct.

Preferred Class Location (choose one):
 Manhattan Bronx Glen Cove, Long Island Buffalo Online / Distance Learning

Full Name of Applicant:   Gender: Male Female

Address:

City or Town:     State: Choose one... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming     Zip Code:

E-Mail:     Phone Number:

Date of Birth (Month/Day/Year):

Education (choose one):
                GED High School Graduate Associate Degree
                Undergraduate Degree Masters Degree or Higher

Vocational / Other Training:


How did you hear about TARP? (check all that apply)
                Recovery Today CDstudies.com Referral
                Search Engine Online Ad ACTTC.com
                Other (please enter below...)
               

Do you have experience in the chemical dependence field? Yes No

If you have experience in the chemical dependence field, please describe:


Why would you like to become a counselor? (maximum reply is 600 characters)

Please carefully review every field in your application before you click to submit.

Contact us for more information about CASAC classes in New York City, Long Island, and Buffalo.