Family Recovery Coach Training

Contact Information

Name*

First Last

Company Name

If applicable

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Demographic Information

Gender

Male
Female

Ethnicity*

Hispanic
non-Hispanic

Race*

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 Information

Date of Birth*

This information is needed to verify that you are at least 18 years of age or older.

Are you over the age of 18*

Yes
No

What's is the highest level of education you have completed?*

Doctoral degrees
Masters degree
Bachelors degree
Associates degree
High school diploma or GED
I have not completed high school and I am seeing a variance

Recovery experience*

Check all that apply

I have experienced a recovery journey as the result of my own substance use or addictive disorder
I have experienced 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

Recovery goals*

Have you set a personal recovery goal and acheived at least one of it's objectives?

Yes
No

Sharing lived experience*

I am willing to publicly identify as a family member in recovery
I am NOT willing to publicly identify as a family member in recovery

How long have you considered yourself in family recovery?*

What does family recovery mean to you?*

What resources have you accessed or systems have you navigated along your recovery journey?*

How have you used your experience to support others?*

Please provide a reference

Please provide a reference person that can attest to your recovery experience as an affected family member of a person with a history of substance use issues, which may have included navigating funding, healthcare or criminal justice systems, participating in support groups, using your lived experience to support others, setting and maintaining healthy boundaries, developing a personal wellness plan or self-care strategies or experiencing self growth and actualization.

Reference Name*

First Last

Reference Email*

Reference Phone*

Primary reason for taking the Family Recovery Coach training:*

Currently employed as a Family Recovery Coach and need training
Currently volunteer as a Family Recovery Coach and need training
Have a job offer and need training
Would like to be employed as a Family Recovery Coach
Would like to volunteer as a Family Recovery Coach
Further my education

Reasonable Accommodations

Are reasonable accommodations for a disability need?

Yes
No

If 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.

Family Recovery Coach Training