Instructions for Completing the Track C Application

Please be prepared to answer all questions in one sitting; once you begin this application you cannot leave and finish later. You can, however, copy and paste answers from a word document into the text fields. You can view the list of questions contained in the application by reviewing the Track C Application Worksheet. Prior to submitting your application, you can go back to any question and modify your answers by scrolling up or down.

Required questions are indicated with an asterisk (*).  

For more information on the Adolescent SBIRT Track C program, please visit:

For questions, please contact

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* 1. Track C Applicant: What is the name of your academic institution, school, department and/or program?*

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* 2. Primary Point of Contact:  What is the contact information for the faculty/educator who will serve as the point of contact for this project?

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* 3. Collaborator Point of Contact:  Is there another school and/or department participating with you?