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AAP I - Clickers Data Example 2

AAP I - Clickers Data Example 2

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Published by stoutaoda

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Categories:Types, Research
Published by: stoutaoda on Dec 08, 2009
Copyright:Attribution Non-commercial

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01/12/2013

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1
Alcohol Education:Alcohol Education:Safety Skills Training ProgramSafety Skills Training Program
Contact Information:
 
UW-Stout Counseling Center
410 Bowman Hall
Menomonie, WI 54751
715-232-2468
September 2009
 
2
n
n
Name Tags
n
Client Information Form (salmon)
n
 Jot Down Instructor’s Names
n
Authorization to Release (gray)
n
Course Fee $80 or $90
Alcohol Education:Alcohol Education:Safety Skills Training ProgramSafety Skills Training Program
 
3
Authorization to ReleaseAuthorization to ReleaseInformationInformation
(gray form)(gray form)
1.Fill in your name & birth date2.Check - “To release to”3.Write class date in - “Dates of Service”4.Individual - fill in only if compliance is not going to court5.Office/Agency – courts (Dunn / Eau Claire)6.Address – fill in court address7.Specific Information to be released by UCC – check compliance form8.9.Sign & Date at bottom

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