CMHA Champlain East

Student Name

Telephone

Program and Year of Study

School

Placement Period

School Contact Information

Teacher/Counsellor

Telephone

Fax Number

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Accomodation Needed

Please outline the goals that you have identified for this period of placement

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Champlain East Branch
329 Pitt Street
Cornwall , K6J 3R1, Ontario
1-800-493-8271
office@cmha-east.on.ca
Hours:
Monday to Friday 8:30am – 4:30pm

Student Placement