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SOS 4.0 Engagement Session #1 - Dayton
Dayton - Summit Region
Monday, March 11th 2024
9:30am - 2:30pm
Northwest Branch Library - Community Room
2410 Philadelphia Drive
Dayton, OH 45406
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?
(Required.)
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)
