Family Recovery Coach Training Family Recovery Coach Training Application To register for a Family Recovery Coach training, complete the following application. Note: There is not yet a TCB certification for Family Recovery Specialists. Choose a trainingWhich training class are you applying for?*Austin - February 24-28, 2020Amarillo - April 20-24, 2020Contact InformationName* First Last Company NameIf applicableEmail* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Demographic InformationGenderMaleFemaleEthnicity*Hispanicnon-HispanicRace*Check all that apply Select All African American / Black American Indian Asian Caucasian / White What languages do you speak or write fluently?* English Spanish Sign Language Other Eligibility InformationDate of Birth*This information is needed to verify that you are at least 18 years of age or older. Date Format: MM slash DD slash YYYY Are you over the age of 18*YesNoWhat's is the highest level of education you have completed?*Doctoral degreesMasters degreeBachelors degreeAssociates degreeHigh school diploma or GEDI have not completed high school and I am seeing a varianceRecovery experience*Check all that apply I have experience a recovery journey as the result of my own substance use or addictive disorder I have experience a recovery journey as the result of a loved one's substance use or addictive disorder I have not had a recovery experience as the direct or indirect result of substance use or addictive disorder Sharing lived experience*I am willing to publicly identify as a family member in recoveryI am NOT willing to publicly identify as a family member in recoveryHow long have you considered yourself in family recovery?*What does family recovery mean to you?*What resources you have accessed or systems you navigated along your recovery?*How you have used your experience to support others?*Letter of Reference*Submit a Letter of Reference, describing how you: 1) reflect recovery principles, 2) have supported other families, 3) have practiced self-care and 4) have maintained healthy boundaries with other familiesAccepted file types: pdf, doc, docx, odt, rtf, txt.Primary reason for taking the Family Recovery Coach training:*Currently employed as a Family Recovery Coach and need trainingCurrently volunteer as a Family Recovery Coach and need trainingHave a job offer and need trainingWould like to be employed as a Family Recovery CoachWould like to volunteer as a Family Recovery CoachFurther my educationReasonable AccommodationsAre reasonable accommodations for a disability need?YesNoIf yes, please describe the accommodation your requesting.Confirmation Signature By signing and submitting this application I acknowledge that my role as a Family Recovery Specialist is and must be completely separate from the role of a Peer Recovery Specialist, a Sponsor or clinician. I acknowledge that recovery is self-guided and that my role as a Family Recovery Specialist includes assisting other family members along their recovery path, which may look different that my own. I commit to completing the 46-hour core curriculum, the 16-hour family endorsement training and virtual community of practice. I understand that RecoveryPeople is pursing a state approved Family Recovery Specialist credential, but there is not guarantee if and when the credential will be approved.Signature*Use your curser (computer mouse) to sign.