Step 1 of 3 33% Contact InformationPlease provide your contact information below.Organization Name* Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* Website What stage of development is your RCO in?* Early planning stage Ready to launch Have started operating in the past year Have been operating for over a year Who is leading the effort to start or operate an RCO?*Check all that apply Select All A volunteer A paid staff person An Executive Director A steering committee A Board of Directors An Advisory Council A task force Does your organization have a mission statement?* Yes No What is your organization’s mission statement?*Select which status applies to your organization:* Currently an independent 501c3 Have applied for 501c3 non-profit status Operating under a fiscal agent (if so, name of fiscal agent) Other Other Status* Fiscal Agent Name* When did your organization become operational?* MM slash DD slash YYYY Recovery Vision Recovery vision is defined in this context as a recovery community organization, its leaders, and members having a singular goal: enhancing the quantity and quality of support available to people seeking and experiencing long-term recovery from addiction. The focus is on the “solution” that involves mobilizing individual and community resources to promote recovery, while embracing all pathways to recovery. Please select from the following to identify your organizations stage of readiness as it relates to recovery vision:*This is a philosophy our organization adheres to and has implemented.This is a philosophy our organization agrees with, but we have not implemented in our operations.This is a new concept for our organization.At least 50% of our organization’s board members are individuals in recovery from substance use disorders.* Yes No The majority of our staff or members are individuals in recovery from substance use disorders.* Yes No Accountability to the recovery communityWe actively engage in a participatory process (we engage participants and stakeholders in decisions and feedback regarding programs and activities).* Yes No We have processes in place to assess the needs of the community and the gaps our organization will fill.* Yes No We provide a way for people to give back to their communities through volunteer and paid service to others seeking recovery* Yes No We work with allied organizations by offering recovery support services, advocating on common public policy agendas, and/or broadening public understanding of the reality of recovery.* Yes No We promote all pathways of recovery.* Yes No We provide only non-clinical services (we do not provide clinical treatment)* Yes No Operational InformationOur organization is engaged in the following:Check all that apply Select All Public Education-Activities that raise awareness about the reality of recovery Recovery Advocacy- Activities that help support or change policies that increase improve the quality of treatment, increase access to recovery supports, and improve outcomes for people with substance use disorders. Recovery support services- Peer Recovery Coaching Recovery support services- Operate a Recovery Community Center Recovery support services- Host meetings and encourage multiple pathways to recovery. Recovery support services- Provide training, education and support for those with Substance Use Disorders. Please use the space below to highlight any activities from the list above.Mentorship GoalsA mentor may provide technical assistance in the following areas. Please indicate where you feel your organization would benefit most from a mentoring relationship. A mentor may provide technical assistance in the following areas. Please indicate where you feel your organization would benefit most from a mentoring relationship. Select All Developing Mission & Vision Statements Implementing Recovery Values and Principles Guidance on Strategic Planning Strengthening Governance Improving Grassroots Advocacy and Community Organizing Creating Public Education and Awareness Initiatives Delivering Recovery Support Services Operating a Recovery Community Center Promoting Multiple Pathways of Recovery Engaging members and staff in the Participatory Process Other Check all that applyPlease Provide Other Areas for Mentoring
