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Attend an Open Class

Learn how our unique doctoral program for practicing clinicians will enhance your clinical experience and expand your career opportunities. Attend an Open Class on site in Chicago or online via our distance learning software. Reserve a seat by registering below or contact our recruitment office at (312) 726-8480, ext. 29.

Name* -- Mr. Mrs. Ms. Address*

City*

State --AAAEAKALAPARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY

Zip*

Daytime Phone Number* Evening Phone Number* Email Address*

Yes, I would like to be notified of news and events at ICSW via this email address.

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Which class would you like to attend?*

Online: Wednesday, November 3, 2010 at 7 pm cst

On-Site: Saturday, November 20, 2010 at 9 am cst

Online: Wednesday, December 1, 2010 at 7 pm cst

On-Site: Friday, December 10, 2010 at 2:30 pm cst

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How did you first hear about the Institute for Clinical Social Work? --- ICSW Alumni or Student ICSW Faculty Member Colleague Classmate or Professor Web Search NASW Newsletter NASW Website Facebook Postcard or Letter Conference or Event Other Advertisement When do you plan to begin taking classes? --- Fall 2010 Fall 2011 Fall 2012 Uncertain What is your current license status? --- Licensed Clinical Social Worker (LCSW) Licensed Clinical Professional Counselor (LCPC) Unlicensed Other

...please describe your license status:

...when will you be eligible for license status (if applicable)? --- January February March April May June July August September October November December --- 2010 2011 2012 2013

Which best describes your current occupation? --- I work in a private practice I work in an agency I work in a school I work in a service program I work in a hospital I attend an MSW program Other

...please describe your occupation:

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