PETRA Direct: CRSW Bootcamp Series Scholarship Application

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* 1. Please, enter your name

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* 2. Please, tell us what town you are located in.

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* 3. Do you currently work in recovery support?

Yes

No

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* 4. Please, tell us how you plan to use the education provided to you in the CRSW Bootcamp Series.

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* 5. Do you plan to provide recovery support services in Coos and/or northern Grafton counties?

Yes

No

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* 6. Do you plan to apply to become a Certified Recovery Support Worker (CRSW)?

Yes

No

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* 7. By applying for this scholarship, I understand that if accepted, I must complete the courses that I am registered for.

Yes

No

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* 8. Please, provide your contact information so that we may contact you regarding this scholarship.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number