Phase 2 Group Selection

Phone Number

Email (subject to terms available at www.rockvilleapp.com/start)

Preferred Method of Contact

Phone

Email (subject to terms in HIPAA acknowledgement form at rockvilleapp.com/start)

Monday at 7:30-9:00 PM (G239) - IN PERSON

I would prefer this time.

I can make this time if I have to.

I cannot make this time.

Tuesday at 5:30-7:00 PM (G241) - online

I would prefer this time.

I can make this time if I have to.

I cannot make this time.

Saturday at 10:00-11:30 AM (G238) - online

I would prefer this time.

I can make this time if I have to.

I cannot make this time.

We will contact you when we have a space available for you.