SUD Allies Host Site Intent to Apply 2021-2022

Thank you for your interest in hosting Substance Use Disorder (SUD) Allies AmeriCorps members. Please complete the following short survey to inform us of your intent to apply.

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* 1. Organization Name

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* 2. Primary Contact

Name

Title

Email Address

Phone Number

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* 3. How many SUD Allies AmeriCorps members do you intend to apply for?

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* 4. Does your organization have experience hosting AmeriCorps members?

Yes

No

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* 5. Provide a brief description of the role you envision for the SUD Allies AmeriCorps member.

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* 6. Would you like to receive technical assistance during the application process? (Technical assistance may include: calls to review the RFA, the application, and/or the proposed position description).

If yes, we will reach out to the contact person listed above.

Yes

No

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* 7. Please indicate if you have any other questions or concerns in the space below: