1.Name

2.Title

3.Organization

4.City

5.State

6.Email

7.Describe your community’s efforts building a recovery-to-work ecosystem that supports the employment of workers with substance use disorder (500 words max)

8.Explain your challenges in building your ecosystem and what types of knowledge and assistance you need (500 words max)

9.Describe your current funding and funding sources you are considering pursuing - including ARC’s INSPIRE Initiative (500 words max)

10.What data about workers or employers do you need to help guide your work? How do you currently use this type of data, what data do you use, and what challenges do you face? (500 words max)

11.I am eligible to receive this assistance as per the guidelines

Yes

No

12.Other questions/comments