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Cape Cod Community College: Addiction Recovery Coach Pre-certification and Wellness Training (ARC)
Please be sure to answer
ALL QUESTIONS
. Enter NA if it does not apply to you.
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1.
Please provide the following contact information.
(Required.)
First Name:
Last Name:
Mailing Address:
City/Town:
State:
Zip Code:
Phone Number (best number to contact you):
Alternate Phone Number (if applicable)
Email Address:
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2.
Date of Birth
(Required.)
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3.
Gender
(Required.)
Female
Male
Prefer not to say
Other (please specify)
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4.
Race (mark all that apply)
(Required.)
Asian
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
White
Other (please specify)
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5.
Ethnicity
(Required.)
Hispanic or Latino
Not Hispanic or Latino
Other (please specify)
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6.
Do you identify as having military or Veteran status?
(Required.)
Yes
No
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7.
Do you receive Supplemental Nutrition Assistance Program (SNAP) benefits and/or TANF/TAFDC? (check all that apply)
(Required.)
SNAP Benefits
TANF/TAFDC
Not Applicable
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8.
Please select the highest level of schooling that you have completed.
(Required.)
Less than 9th grade
9-12 grade, no diploma
High school diploma
GED/high school equivalency
Some college, no degree
Associate's degree
Bachelor's degree
Master's degree and above
Other post-secondary education (please specify)
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9.
What is your current employment status?
(Required.)
Employed Full-Time (35+ hours per week)
Employed Part-Time (Less than 35 hours per week)
Unemployed
Other (please specify)
10.
Where do you currently work?
11.
What is your job title?
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12.
This program was developed and designed for individuals in recovery (with at least 9 months of sobriety) and individuals with lived experience.
(Required.)
I certify that I have at least 9 months of sobriety and/or lived experience.
Other (please specify)
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13.
This program requires motivation and self-discipline, as you will be required to work both independently and online. Are you comfortable being in an online learning environment?
(Required.)
Yes
No
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14.
Are you in need of a laptop to participate in this program? (student loaner laptops may be available to those in need)
(Required.)
Yes
No
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15.
Do you have direct experience in the field of recovery and/or support services?
(Required.)
Yes
No
16.
If you have direct experience, briefly describe your work experience.
17.
If you do not have direct experience, do you have related experience you would like to share?
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18.
Specifically, what attracts you to pursuing the Addiction Recovery Coach credential?
(Required.)
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19.
Why do you want to participate in this program?
(Required.)
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20.
What do you hope to gain from your participation in this program?
(Required.)
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21.
How did you hear about this opportunity?
(Required.)
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22.
Two Letters of Reference Required: We are grateful that we have once again been entrusted with grant funds to offer our Addiction Recovery Coach Pre-certification and Wellness Training Program. To help us make informed choices in our selection process, we're asking you to submit two letters of reference prior to acceptance: one letter from a character reference and another letter from a performance reference (paid or volunteer work or student/program participant). Email both letters using your full name in the email subject line to smcleod@capecod.edu or mail letters to: Cape Cod Community College, Hyannis Center, Attn: Steve McLeod, 540 Main Street, Hyannis, Ma 02601.
(Required.)
I understand that two letters of reference are required for my application to be considered.
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23.
Disclaimer: By typing my name below, I am signing this application electronically. I agree that my electronic signature is the legal equivalent of my manual signature on this application. I hereby certify and attest that the information stated above is true and accurate. I acknowledge that the information on this application may be used for evaluation purposes by Cape Cod Community College, Massachusetts Department of Higher Education, and Massachusetts Association of Community Colleges.
(Required.)
