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Inquiry Card
By submitting this form, you are giving a GRCC
Community Health Worker and Health Support Workers Training Program
representative permission to contact you. Thank you.
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Address
*
Your answer
Phone number
*
Your answer
Preferred Method of Contact
*
Text
Email
Call
Preferred time to contact you
*
Time
:
AM
PM
Do you currently have a high school diploma (not required)
*
Yes I have a high school diploma
What program or programs are you interested in?
*
Certified Nurse Aide
Community Health Worker
Direct Support Professional
Medical Assistant
Pharmacy Technician
Other:
Required
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