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.)

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2. Date of Birth (Required.)

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3. Gender (Required.)

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4. Race (mark all that apply) (Required.)

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5. Ethnicity (Required.)

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6. Do you identify as having military or Veteran status? (Required.)

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7. Do you receive Supplemental Nutrition Assistance Program (SNAP) benefits and/or TANF/TAFDC? (check all that apply) (Required.)

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8. Please select the highest level of schooling that you have completed. (Required.)

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9. What is your current employment status?  (Required.)

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10. Where do you currently work?

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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.)

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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.)

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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.)

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15. Do you have direct experience in the field of recovery and/or support services? (Required.)

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16. If you have direct experience, briefly describe your work experience.

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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.)

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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.)

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