Hesed Inquiry

Student Information

Student First Name

Student Last Name

Student Email Address

Student Phone Number

When will you like to start the Hesed Transition Program?

Please list your physical or mental health diagnoses that are currently applicable

Please enter your high school

What extracurriculars are you interested in? (Optional)

Parent/Guardian Information

Relationship

First Name

Last Name

Phone

Questions/Comments

By submitting this form, you agree to be contacted about Concordia's degree and program offerings, and to receive marketing messages sent via email, phone call or SMS. Message frequency varies. Message and data rates may apply.

HIDDEN - Hesed program