Family Coaching Specialty Training Application
Which Family Training are you interested in attending?
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Please Select
May 23 & 24, 2022
Name
*
First Name
Last Name
Email
*
example@example.com
Confirm Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of the organization where you work or volunteer
*
Have you completed the Vermont Recovery Coach Academy?
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Please Select
Yes
No
If yes, when did you complete the Academy?
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Are you a Certified Recovery Coach (CRC)?
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Unsure of what this means? Visit our website here for more information: https://recoveryvermont.org/recovery-coach-certification/
Do you identify as a person in recovery?
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If so, how long have you been in recovery?
Do you have permission from your supervisor?
*
Please Select
Yes
No
Supervisor's Name
*
First Name
Last Name
Supervisor's Email
*
example@example.com
Supervisor's Phone
*
Please enter a valid phone number.
How did you hear about this training?
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Facebook
Instagram
Recovery Vermont Newsletter
Website
Word of Mouth
Listserv Emails
Other
What do you hope to learn from this training? (there are no wrong answers!)
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Do you require any special accommodations and/or would you like the facilitator to know anything about your needs and/or learning styles?
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Submit
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