Online Courses Registration

Thank you for your interest in the Executive Certificate in Home Modification program. You will receive an Invoice within 72 hours of completing this Registration Form.

Cancellation Policy: Once paid, refunds are only provided if student notifies the Program Office at homemods@usc.edu 48-hours in advance of the course start date, or due to extenuating circumstances.

Salutation

*First Name:

Middle Initial(s):

*Last Name:

Title

Organization

*Address:

*City:

*State/Province/Region:

*Postal/ZIP Code:

*Country:

*Daytime Phone:

*Evening Phone:

*Fax:

*Email:

Mr. Mrs. Ms. Dr.

EXECUTIVE CERTIFICATE PROGRAMS ONLY

COURSE 1: The Basics and Beyond (May 21 - June 7, 2013)

COURSE 2: How to Get It Done (June 11 - 28, 2013)

COURSE 3: Funding Resources & Financing Mechanisms (July 9 - 26, 2013)

COURSE 4: Raising Community Awareness & Coalition Building (August 13 - 30)

COURSE 5: The Ethics of Home Modification (September 3 - 10, 2013)

All courses above (required for the Executive Certificate).

How did you find out about us?

By web site, www.homemods.org

By other web site:

By professional organization:

By word of mouth

By advertisement:

By other means:

A project of the National Resource Center on Supportive Housing and Home Modification,
in affiliation with the Fall Prevention Center of Excellence, funded by the Archstone Foundation.
Located at the University of Southern California Andrus Gerontology Center, Los Angeles, California 90089-0191 (213) 740-1364.