Residential Counselor Core Training (RCCT) Course Registration

If this is your first time registering, please call to provide your social security number at 1-800-852-3345, ext. 6625.

*Indicates Required Field

*First Name :
*Middle Name (if no middle name enter none) :
*Last Name :
*Date of Birth :	/ /
*Home Address :
*City :
*State :
*Zip Code :
*Home Phone Number :	()-
Work Phone Number :	()- x
Email Address :
Residential Staff, name of facility :
Other, name of organization :
*Are you a US citizen?
If not a US citizen, select one :
If you have a disability which may require special services,
please check here :
Please complete the following information for each class for which you are registering:
Course 1
Course Registration Number :
Course Title :
Course Location :
Course 2
Course Registration Number :
Course Title :
Course Location :
Course 3
Course Registration Number :
Course Title :
Course Location :
Course 4
Course Registration Number :
Course Title :
Course Location :
Course 5
Course Registration Number :
Course Title :
Course Location :
Comments :
To enroll in additional classes, please submit another registration.

Academics