On-Line Inquiry Form For the School of Human Services

If you would like more information about School of Human Services programs or the admissions process, please complete the form below. If you have questions regarding admissions you can (413) 748-3985.

	Individual Information:
*First Name:
*Last Name:
Middle Initial:
Are you a U.S. citizen/permanent resident?	Yes No
	Home Information:
*Street Address:
*City:
*State (US):	Choose one AK AL APO-AA APO-AE APO-AP AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY
*Zip:
Country:
*Telephone:
Fax:
Email Address:
	Program of Interest:
Intended Entry:	Spring 2013 Summer 2013 Fall 2013 Spring 2014 Summer 2014 Fall 2014 Spring 2015 Summer 2015 Fall 2015
Campus of Interest:	Location Boston MA Charleston SC Houston TX Manchester NH Milwaukee WI St. Johnsbury VT Southern CA Springfield MA Tampa FL Wilmington DE Exec. Master's
Program of Interest:	Choose one undergraduate human services graduate human services Executive master's program
Materials Requested:	Information Application
What most influenced this inquiry?	Choose one Alumnus/a Viewbook Student Catalog Guidance Counselor Campus Visit YMCA Professional Reputation ECAC Website Other
	If you chose "Other," please describe.
Comment (if any):
	Date Submitted: 06/19/2013 09:01 AM