Corrections & Re-entry Specialty Training Application (September 2021)

Corrections & Re-entry Specialty Training Application
Which Corrections training are you interested in attending?*
Name*

First NameLast Name
Email*
example@example.com
Confirm Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of the organization where you work or volunteer *
Have you completed the Vermont Recovery Coach Academy?*
If yes, when did you complete the Academy?*
Do you identify as a person in recovery?*
If so, how long have you been in recovery?
Do you have permission from your supervisor?*
Supervisor's Name*

First NameLast Name
Supervisor's Email*
example@example.com
Supervisor's Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Do you require any special accommodations and/or would you like the facilitator to know anything about your needs and/or learning styles?*
Should be Empty: