The Center for Social Training: Derner Institute: Adelphi University

Interest Form

Filling out this form does not oblige you or your child to apply or participate in Adelphi’s Center for Social Training. The purpose of this form is merely a point of contact for us to reach out to you closer to the start of the program.

Your First Name:
Last Name:
Child's First Name:
Child's Age:
Address Line 1:
Address Line 2:
State:
ZIP Code:
Home Number:
Cell Number:
Email:
Spectrum Disorder:
Comments

Contact
To set up an appointment or for additional information, please contact:

The Center for Social Training
Gordon F. Derner Institute
Hy Weinberg Center, Garden City, NY 11530
e - socialcenter@adelphi.edu

This page last modified on May 12, 2009.

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