1. Organization Name *
3. Email address of Executive Director *
4. Phone number of Executive Director: *
6. Title/position of individual completing application *
7. Email address of individual completing this application *
8. Email address for application follow-up *
9. Street address *
10. Organization website *
11. Please provide your organization’s mission statement: *
12. Please provide your organization’s vision statement: *
a) Recovery vision: This is your organization’s recovery vision statement for the community you serve. EX: “A community in which no one loses their life to SUD.” [Recovery community organizations focus on the reality of long-term recovery from addiction to alcohol and other drugs. The recovery community organization, its leaders, and members have a singular goal: enhancing the quantity and quality of support available to people seeking and experiencing long-term recovery from addiction.] *
b) Authenticity of voice: Through this principle, please tell us how your organization is using the voice of the recovery community to inform programs and services you provide. Also include how your organization is made up of recovery community members. [RCO’s represent the interests of the recovery community. A guiding principle is selfgovernance, mutual aid, and support. RCO’s are developed to serve communities, with leadership by and for community members.] *
c) Accountability to the recovery community: Tell us how your organization is providing services based on the needs of the recovery community and adapts to evolving needs over time. Also include if you conduct informal or formal assessments or surveys. [RCO’s credibility and effectiveness depends on their ability to be accountable and responsive to the community they work in and with, this means being an independent, stand-alone nonprofit organization, where they can manage their relationships with other organizations. Independence allows a recovery community organization to bridge the gaps between the recovery community and government agencies, the criminal justice system and the larger network of health and human services providers. The recovery community organization’s real strength is drawn not from its links to other service organizations but from the authentic voice of the individuals in the recovery community who relate to and actively support it.] *
15. How many paid staff members does your organization have? *
16. How many volunteers does your organization have? *
i. If operating under a fiscal agent, please provide the name of the organization
2. Please describe the makeup of your Board of Directors, including the number of individuals on your Board. *
3. What percentage of your Board members identify as being in recovery from substance use disorder? *
a. Public Education: Educate the public, policy makers, service providers, and the media about the reality of recovery offers hope and dispels myths and pessimism about the power and reality of long-term addiction recovery. This strategy also draws attention to the social and policy barriers facing people in and seeking recovery. *
b. Recovery Advocacy: Addressing the public policy barriers that keep people from sustaining their recovery long term. Advocacy is aimed at ending the punishment and incarceration of people for their status as people with histories of addiction. *
c. Peer and other recovery support services: Deliver a variety of peer recovery support services and places to deliver those services which include recovery coaching, telephone recovery support services, all-recovery meetings, and community-wide safe social activities, workshops, meetings, and resource connections. *
a. If you answered yes to the above question, please provide details regarding clinical treatment services offered by your organization: *
b. If your organization provides clinical treatment services what percentage of these services makes up the annual budget/funding for your organization? *
3. Please describe how your organization engages members of the recovery community in service and program development: *