RSS Learning Collaborative Application

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Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Name
Employer City
Employer County
Employer Type

Not Currently EmployedRecovery Community OrganizationClinical Treatment ProviderMedication Treatment ProviderHealth SystemThird Party PayorHospitalFQHCCMHCCBHCRecovery ResidenceTransitional Housing ProgramRe-entry ProgramSocial Service OrganizationLocal Government AgencyState Government AgencyProfessional Membership OrganizationJail / PrisonProbation / Parole DepartmentOther
Job Role Type*

Peer SpecialistPeer SupervisorResearcherClinical ProviderMedical ProviderNurse (Any Type)AdministratorPolicy MakerGovernment OfficialOther
Which best describes the community you work in?*

FrontierRuralSuburbanUrbanTribal CommunitySmall TownLarge TownDigital Community (Websites, Social Media, Telephone, Video, etc)Virtual Community (Virtual Reality)Other
What topics are you most interested in learning more about?*

General Recovery Support Service DeliveryDigital Recovery Support ServicesVirtual Recovery Support ServicesRecovery Planning / WRAP PlanningOverdose Prevention and ResponseXylazine (Tranq) Overview and Care DeliveryGeneral Harm Reduction ServicesWound Care ServicesDrug Checking ServicesSyringe Service ProgramsRecovery Friendly WorkplacesStigma and LanguageFamily Support ServicesRecovery Outcomes Data and AnalyticsRecoveryLink Use and Best PracticesRSS Cost AnalysisRSS IntegrationPeer SupervisionPeer Workforce DevelopmentCommunity Needs Assessment and MappingRe-entry or Forensic Peer ServicesPregnant and Postpartum Peer ServicesCommunity Outreach Best PracticesRecovery HousingRCO and Peer Service History and ModelsRCO Administration and LeadershipRecovery Science and ResearchOther
Anything else we should know about you?
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