Question Title

* 1. Please complete the information for the agency interested in hosting a PRSS intern.

Question Title

* 2. Please complete this information for the agency internship contact.
This would be the individual that will receive primary communication from Governors State University with regards to internship placements, intern expectations and intern supervision.  

Question Title

* 3. Please complete this information for the agency legal contact.  
This would be the individual at your agency that is able to legally sign contracts and agreements on behalf of the agency.  This individual may be located at a different location then the internship contact. 

Question Title

* 4. What are your agency's hour of operation?

Question Title

* 5. If your agency has multiple physical locations that could host a PRSS intern please list the location names and cities in which they are located.

Question Title

* 6. Please check all that are required for an intern to have to work at your organization:

Question Title

* 7. Does your agency require that an intern be currently in personnel recovery?  If yes, please include the length of time

Question Title

* 8. How far in advance do you need to know about an internship placement?

Question Title

* 9. Can you briefly describe any application process the intern will need to complete at your agency in order to be eligible?

Question Title

* 10. Briefly explain what roles a Peer Recovery Support Specialist Intern would engage in at your agency?

Question Title

* 11. Please mark any populations your agency specializes in working with?
We understand you may serve all of these populations but only select group if they are a target group for your agency or your agency has requirements regarding an individual identifying as one of the following in order to receive treatment. 

T