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* 1. Name of organization

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* 2. Name of lead applicant

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* 3. Names and titles/roles of 3 to 4 other staff who will participate

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* 4. Type of organization or program

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* 5. In order to participate in this learning collaborative, your organization must be a direct employer of peers.

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* 6. Primary population served

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* 7. State

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* 8. City

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* 9. Please share why you’re interested in participating in this learning community series.
(Please expand beyond one or two sentences)

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* 10. By the end of the series, what concrete changes do you hope to make at your organization?
(Please expand beyond one or two sentences)

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* 11. The organization where I work:

  Strong Disagree Disagree Neutral Agree Strongly Agree
Has a nuanced understanding of the peer ethos, values, and history.
Has intentionally designed policies and procedures that take into account the peer ethos, values, and history.
Does not require adherence to specific recovery pathways. (e.g. abstinence, participation in therapy, periods of time in recovery) in its hiring of peer recovery support specialist staff
Has training for non-peer staff on the value of peer support and how it contributes to achieving the organization’s mission.
Has supervision that is appropriate for peer practice.
Please be aware that participation in this learning community series is extremely limited and we are looking for a cohort of organizations that are committed to engaging with the series and implementing change. Keep in mind that if your organization is selected to participate there is an expectation that you will stay engaged with the series for all 6 months.

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* 12. By submitting this application, I understand and commit to:

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