Behavioral Health & OASAS Program Interest Form

Behavioral Health & OASAS Program Requirements:

The Behavioral Health (BHWET) & OASAS Opioid Settlement Fund (OSF) Scholarship program and/or its affiliate clinical agencies may require background checks and drug screenings. Students with concerns should alert BHWET & OASF staff prior to applying to program to ensure ability to successfully complete program requirements.

BHWET & OSF must be able to check income to determine best scholarship placement. This is done through the completion and submission of the FAFSA with the SUNY FMCC Financial Aid Office. These must be completed first before application can be reviewed. Please indicate below that you understand the above requirement.

First Name

Middle Name

Last Name

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Email Address (Please use your personal email)

Home Phone Number

Cell Phone Number

May we text you with important Updates?

Yes

No

Program of Study:

Human Services

Addiction Services

Other:

Degree or Certificate:

2-Year Degree Program

Certificate Program

Full-time/Part-time

Full-Time

Part-Time

When would you like to start:

Fall 2024

Spring 2025

Fall 2025

Have you filed your FAFSA?

I have filed my FAFSA with the SUNY FMCC Financial Aid Office.

I have not filed my FAFSA with the SUNY FMCC Financial Aid Office.

How did you hear about this program?

Consent

I have read the above statement and understand that, if required, I will alert staff of concerns regarding background checks and drug screenings.