Recovery Coaching in the Emergency Department Training Application
Which training are you interested in attending?
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Please Select
August 10th & August 11th
Name
*
First Name
Last Name
Email
*
example@example.com
Confirm Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Recovery Center do you work with?
*
Have you completed the Vermont Recovery Coach Academy?
*
Please Select
Yes
No
If yes, when did you complete the Academy?
*
Does your Supervisor formally recommend your attendance at the RCED training?
*
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?
*
Facebook
Instagram
Recovery Vermont Newsletter
Website
Word of Mouth
Listserv Emails
Other
Please tell us about why you are interested in working in the Recovery Coaches in the Emergency Department Program.
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In your opinion, what are your strengths as a Recovery Coach? Which areas would you like to strengthen?
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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?
*
Submit
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