SNAP E&T Orientation Contact Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Asnuntuck Community College

First Name *

Last Name *

Date of Birth *

YYYY

Email *

Street Address *

City/Town *

Zip Code *

Phone number *

Do you have a high school diploma or GED? *

Yes

Have you ever been enrolled in a SNAP scholarship program at another college? *

Yes

DSS Client ID Number (The 9-digit number on your EBT card) *

Training program(s) that you are interested in. Check all that apply.

Certified Pharmacy Technician

Ophthalmic Assistant

Veterinary Assistant

Dental Assistant

Sterile Processing Technician

Emergency Medical Technician (EMT)

CNA/Certified Patient Care Technician

Medical Billing and Coding (CPC-Certified Professional Coder)

Personal Trainer

Phlebotomy Technician

EKG Technician

Nail Technician

Esthetician

IT Help Desk Technician

Not Sure

Please Check Orientation Date (Will be WebEx or MS Teams)

A WebEx or MS Teams Invitation Link will be sent a week before the orientation to your email address. To attend the orientation please accept the invite.

I will send an invite a week before the orientation *

Option 1

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms