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Thank you for your interest in Howard County Health Department’s Tobacco Awareness Program.

This free education program is designed for students who violate school policy on underage tobacco use. This program includes information about the risks and harms of using:

   - Tobacco (cigarettes, cigars, cigarillos, smokeless tobacco)
   - Electronic Cigarettes
   - Dissolvable Products
   - Marijuana

Please complete this online enrollment form.
Our Community Health Educator will respond within 3 business days upon receipt.

Question Title

* 1. Please complete the following information

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* 2. How did you hear about this program:
(Check all that apply.)


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* 3. Relationship to student: