Apply for Recovery Coach Training Recovery Coach Training Application If you are interested in Recovery Coach Training, complete the following information, which is required by the State of Texas. Your Name* First Last Your Phone*Your Email* Your Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code What is your highest level of education?* High school degree or GED Associates Degree Bachelor Degree Masters Degree Doctorate Degree None of the above HiddenDo you have at least a high school degree or GED Yes No Citizenship status*What state?What country?What is the year of your birth?*Gender*How do you self identify? Male Female Sexual Orientation*How do you self identify? Heterosexual/Straight Bisexual Homosexual/Gay/Lesbian Are you of Hispanic or Latino/a descent?* Yes No What is your race?*Choose all that apply African American / Black Asian American Indiana / Native Alaskan Pacifica Islander / Native Hawaiian White Are you a veteran?* Yes No What languages do you speak?* Are you?*Check all that apply In recovery from substance use issues Not in recovery, but am family/friend of someone in recovery Not in recovery, but am a recovery ally Licensed Addiction Professional Other How long have you been in recovery? Briefly tell us about your recovery story.*Are you currently volunteering or working at an organization that provides Recovery Support Services?* Yes No Where are you currently volunteering or working?*OrganizationRepresentative/SupervisorContact info How do you plan on using your Recovery Coach training?*What's the purpose of you taking this training?* I am going to pursue / am pursuing the certification credential I do not plan on pursuing a recovery coach credential I am not familiar with the certification credential or credentialing process. Where will you complete the required supervision and field experience hours?*OrganizationRepresentative/SupervisorContact informationIn addition to your experience, what other ways can people experience/find recovery?*Is there anything lived experience (e.g trauma or life disruptions) that you might use as a recovery coach?Not required. Share at the level of your comfort.
