Addictions Counseling Certificate Program Application

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Thank you for your interest in the Addictions Counseling certificate program at Worcester State University. To apply for admission, please complete and submit this online application along with the additional application components listed at the end of this application. If you need more information regarding the program, visit https://www.worcester.edu/programs/certificate-in-addictions-counseling/.

First Name *

Middle Name

Last Name *

Email Address *

Mailing Address

Street Address *

City *

State *

Zip Code *

Complete Home Address (if different from mailing address)

Include Street, City, State and Zip Code

Best phone number at which to reach you *

Last 4 digits of your Social Security Number

Worcester State Student ID# (if applicable)

If you are a former Worcester State student, list any other name under which your record may be listed (maiden name, etc.)

Date of Birth *

Ethnicity (optional)

Non-Hispanic

Hispanic

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Race (optional)

American/Alaskan Native

Hawaiian/Pacific Islander

Asian

Black or African American

Cape Verdean

White

Other:

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Admissions Requirements - Check all the apply

I possess a high school diploma or GED

I have successfully completed PS 101 General Psychology or its equivalent

I have not successfully completed PS 101 or its equivalent and plan to take the course at Worcester State before admission to the certificate program

If you have attended any other colleges or universities, please list them here. You will need to request transcripts from each of these schools and have them forwarded to the Division of Graduate and Continuing Education at Worcester State University.

A $30 application fee payable to Worcester State University and official transcriptions from all colleges/universities you have attended are required in order for your application to be considered complete.

All application materials submitted become the property of Worcester State University and cannot be returned to you or used for any other purposes except as noted. Information furnished to Worcester State university will be kept confidential and will only be released to personnel authorized to receive this information.

This program is completed on a part-time basis and is not eligible for F1 visas or federal financial aid.

By checking this box, I certify that I understand the information presented above and that the information provided on this application is complete and accurate.

Required

Please mail transcripts and application fee to:

Division of Graduate and Continuing Education

Addictions Counseling Certificate Program

Worcester State University

486 Chandler Street

Worcester, MA 01602

Official transcripts may be submitted via email to dgce@worcester.edu

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