Higher Education Center: Feedback Form

Feedback Form

Please feel free to use this form (or see our other contact information) to request something of our Center or provide feedback. We can provide assistance regarding alcohol and other drug use/abuse prevention (and related issues) for Higher Ed. Make sure you leave us your email and/or phone contact information. Thank you.


Name:          
Email:         (required)
Title/position:
Affiliation:   
Phone:             Fax:
Street:        
City:            State:   Zip:

__________________________

Are you affiliated with an institution of higher education?
Yes No
If so, is the school:
2-year or 4-year
Public or Private
Community or State
religious affiliation and/or proprietary or Other:
__________________________

How did you find our Web Site?
Is there a particular request you have now?

Do you have any additional comments?

Thank you for your time!

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Send e-mail to HigherEdCtr@edc.org