Name of Institution:

Department/School:

Contact Person:

Email Address:

Phone Number:

Website Address:

Please indicate the type of substance abuse curriculum or program you offer by marking the appropriate boxes below.

GRADUATE: (Check all that apply.)

UNDERGRADUATE: (Check all that apply.)

Certificate
Degree
    Associate
    Bachelor
        Major
        Minor
Concentration
Track

Number of Semester Credit Hours in Program:

Program Focus

Prevention
Treatment
Other

Thank you for responding to this survey. The information provided will be very helpful in the development of future substance abuse professionals in the State of Michigan

Return form by March 21, 2008 to Donald L. Allen, Jr., Director, Michigan Office of Drug Control Policy, in care of Simonma@michigan.gov or by U.S. mail to: Donald L. Allen Jr., Director, Michigan Office of Drug Control Policy, Lewis Cass Bldg., 5th Floor, 320 S. Walnut St., Lansing, MI 48913

On-line form can be found at: www.michigan.gov/odcp