Advance Registration Notice

1. Name
2. Agency Name
3. Address
4. Contact telephone
5. Course titleDate(Please submit which date)
6. Must list E-mail address
7. Please print this page before submitting: (This confirms registration and equipment list needed for class)

Course: Mental Health Officer (reported as 4001 with TCLEOSE)

Tuition: $55.00

Start/End Date: Jan 20-22 or Sept 27-29, 2010 (24-hrs)

Start Time: 8:30 AM

Room#: TBA

Dress: Clothing suitable for classroom lecture

Material to Bring:
Pen and paper
TCLEOSE PID# (is required for credit)