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SOS 4.0 Engagement Session #5 - Columbus
Columbus - Twin Valley Region
Friday, March 29th 2024
9:30am - 2:30pm
Columbus Metropolitan Library - Auditorium
96 South Grant Avenue
Columbus, OH 43215
Pre-registration and Survey
*
1.
Please enter your name and contact information
(Required.)
Name:
E-mail:
Organization (if applicable):
*
2.
Are you a past or current SOR/SOS grantee?
(Required.)
Yes
No
3.
Please select from the list below what best describes your current role?
Program Administrator
Government Official
Law Enforcement
Peer Supporter
Clinician
EMT or other First Responder
Prevention Specialist
Teacher
Social Worker
Other (please specify)
4.
Have you ever personally administered an overdose reversal?
Yes
No
*
5.
Are you an individual with lived experience or in recovery from mental health or substance use issues? If so, please check one from the list below:
(Required.)
No
Mental Health (MH)
Substance Use Disorder (SUD)
Co-occurring MH and SUD
Other (please specify)
