Peer Recovery Coach Scholarship

(Please read and answer each question carefully)

Name(Required)
Address(Required)
What best describes you?(Required)
Mark only one oval.

What best describes you?(Required)
Mark only one oval.

Are you a Recovery Court (ACDC, HEALS), DUI Court, DV Court, or Veterans Trauma Court graduate or participant?(Required)
Check all that apply.
Are you an FTDC Graduate or Participant?(Required)
Check all that apply.
Are or were you involved in Corrections?(Required)
Mark only one oval.
Have you ever been hospitalized due to substance use disorder?(Required)
Mark only one oval.
Have you ever served in the military?(Required)
Mark only one oval.
Are you receiving SNAP benefits? *(Required)
Check all that apply

Section Break

1. There are more important things to me in life than using substances. *(Required)
Mark only one oval 1= strongly disagree - 6 strongly agree
2. In general I am happy with my life.(Required)
Mark only one oval 1= strongly disagree - 6 strongly agree
3. I have enough energy to complete the tasks I set myself.(Required)
Mark only one oval 1= strongly disagree - 6 strongly agree
4. I am proud of the community I live in and feel part of it.(Required)
Mark only one oval 1= strongly disagree - 6 strongly agree
5. I get lots of support from friends.(Required)
Mark only one oval 1= strongly disagree - 6 strongly agree
6. I regard my life as challenging and fulfilling without the need for using drugs or alcohol.(Required)
Mark only one oval 1= strongly disagree - 6 strongly agree
7. My living space has helped to drive my recovery journey.(Required)
Mark only one oval 1= strongly disagree - 6 strongly agree
8. I take full responsibility for my actions.(Required)
Mark only one oval 1= strongly disagree - 6 strongly agree
9. I am happy dealing with a range of professional people.(Required)
Mark only one oval 1= strongly disagree - 6 strongly agree
10. I am making good progress on my recovery journey.(Required)
Mark only one oval 1= strongly disagree - 6 strongly agree
I acknowledge SRC's nonprofit status and limited resources. I understand scholarships are not guaranteed, and I may be asked to find alternate funding for my training.(Required)
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