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CEHS Request for Information Revised
Full Name
Address
City, State, Zip
Telephone Number
answer must be phone number with area code like 217-333-1000
Email address
answer must be an email address
Check the box next to the program of interest to receive further information.
(Check all that apply)
I would like information about the Undergraduate Programs:
Check the box next to the program of interest to receive further information.
(Check all that apply)
Social Work
Elementary Education
Middle Grades Teacher Education
Secondary Teacher Education
Other
I would like information about the Graduate Programs:
Master's of Education
Master's of Educational Leadership
Clinical Mental Health Counseling
Marriage, Couple & Family Counseling
School Counseling
Other
If you chose "other", how may we assist you?
