Professional Information

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Please fill out the following information form so that we can be certain that we have current, updated information on all members and other safe schools professionals.
Your contact information will not be shared without your permission.

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PROFESSIONAL INFORMATION

Name
Street Address
City
State
Zip Code
Contact Number
Organization
E-mail

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Membership Status

Yes, I am a member of the LASDFSC.
I am not a member of the LASDFSC.

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Other Information
Please check all that apply.

I am a safe and drug free schools coordinator.
I work closely with safe and drug free schools issues.
I am a Licensed Prevention Professional.
I am interested in trainings that will assist in achieving certification.

Please publish my contact information at lasdfsc.4t.com.
Please keep my information confidential.

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