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Recovery Community Organization
Impact Statement
Awards
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Programs
Peer Recovery Specialist
Telephone Recovery Support
Parent Recovery Liaison
Chemical Health Assessments
Intensive Outpatient Treatment- Short Term and Long Term
Recovery Housing- Join Our Journey (JOJ)
Jail and Prison Peer Recovery Support
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Recovery Ready Region
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Contact Information
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Last Name
Email
Address
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Zip
Phone 1
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Yes
Phone 2
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Yes
Employer Information
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Volunteer Availability/Interest
Please indicate the days and times you are usually available to volunteer. (Select all that apply)
Monday Morning
Monday Afternoon
Tuesday Morning
Tuesday Afternoon
Wednesday Morning
Wednesday Afternoon
Thursday Morning
Thursday Afternoon
Friday Morning
Friday Afternoon
Saturday Morning
Saturday Afternoon
Sunday Morning
Sunday Afternoon
Which areas of Recovery Is Happening would you like to support?
Telephone Recovery Support
Recovery Coach
Gala
Recovery Works Committee
Recovery Walk
Advocacy
Other Special Events
Outreach
Advocacy
Outreach
Demographic Information
What is your birth date?
Gender
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male
female
prefer not to answer
other
Other languages in which you are fluent (select all that apply):
Spanish
Somali
Hmong
Vietnamese
Russian
Bosnian
References
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Last Name of Reference #1
Your Relationship to Reference #1
Occupation of Reference #1
Phone for Reference #1
Email for Reference #1
Reference #2
First Name of Reference #2
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Occupation of Reference #2
Phone for Reference #2
Email for Reference #2
Reference #3
First Name of Reference #3
Last Name of Reference #3
Your Relationship to Reference #3
Occupation of Reference #3
Phone for Reference #3
Email for Reference #3
Emergency Contact Information
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Relation
Emergency Contact Home Number
Emergency Contact Cell Number
Emergency Contact Work Number
Signature
(By typing my full name in the box below, I affirm that the above information is accurate)
Home
About Us
Recovery Community Organization
Impact Statement
Awards
Board of Directors
Staff
Programs
Peer Recovery Specialist
Telephone Recovery Support
Chemical Health Assessments
Intensive Outpatient Treatment- Short Term and Long Term
Parent Recovery Liaison
Recovery Housing- Join Our Journey (JOJ)
Advocacy
Training
Events
Volunteer
Get Help!