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ACEP Program Application
Addictions Counselor Educational Program (ACEP)
Please complete the application below.
Begin the multi-page application below.
Page 1
Contact Information
First Name:
Last Name:
Address:
Address:
City:
State:
Phone:
Email:
Are you currently employed?
Employment status?
Yes
No
Where are you employed?
How did you hear about the ACEP program?
Method?
Please select...
Email
Friend
Social Media
Website
Word of Mouth
Other
If other, please explain
Page 2
Education
Please list the school's name, location, and years attended (or year graduated) for the following:
High School/GED, other training, certificates, military, trade school, etc.
Associate's or bachelor's degree or # credits towards degree / Major(s)
Advanced Degrees or graduate credits / Major(s)
Professional Licenses
Do you have experience in Human Services?
Yes
No
Describe your experience:
Page 3
Financial Information
Note: The UMass Boston ACEP Program is not eligible for FAFSA-based financial aid.
How would you prefer to pay for the program? Check all that apply
Self-Pay
Interested in UMASS payment plan
Loan
Do you have a third-party payor such as MASS REHAB, VA, employer, etc.?
Professional References
Reference #1
First Name
Last Name
Relationship
Phone Number
Email:
Reference #2
First Name
Last Name
Relationship
Phone Number
Email:
Interest
Please explain your interest in the ACEP Program and your goals upon completing the program:
Acknowledgement
By clicking the checkbox, I understand my information will be shared with university staff to complete my request.
Acknowledgement
Contact Information