Underage Possession of Tobacco Agency Commitment Form

UPT Agency Commitment Form

Below are some strategies to help you lower your risk related to tobacco use. These ideas have worked well for other students, youth and young adults. Please check those you have tried or those that might be useful to you.

Preparing to Quit
Social Situations

This section of this document, including your name, will be available to your referring agency if requested. This document is a commitment or agreement to future behaviors related to tobacco use. This document does not reflect any admission or denial of any prior action.

please sign with your full name