Maine RecoveryCorps Pre-Screening Questionnaire
Healthy Acadia is launching a new AmeriCorps initiative, the RecoveryCorps Program, which is focused on expanding Recovery Coaching to strengthen recovery support services in our communities and to improve recovery success among individuals facing substance use disorders, with an emphasis on opioid use disorders.

Recovery Coaching is an innovative and effective form of peer-to-peer recovery support. RecoveryCorps coaches will serve as personal guides and mentors for people seeking recovery, helping them remove barriers and navigate systems to meet their treatment, wellness and recovery support goals. Healthy Acadia, along with multiple other organizations across a six-county service area (Aroostook, Hancock, Knox, Penobscot, Waldo, and Washington) are engaged in this program. Each RecoveryCorps member will serve at an organization in one of these regions and provide peer recovery coach services to those seeking recovery. We are seeking full-time and part-time members.

All potential RecoveryCorps Coaches must have at least one year of active involvement in their recovery process, if they self-identify as being in personal recovery from substance use. People with a commitment to the recovery process who do not have personal histories of past drug or alcohol use are also encouraged to become recovery coaches, if they have strong demonstrated personal experience with the recovery process.

A recovery coach has to be a role model for others seeking recovery. RecoveryCorps Coaches honor all paths to recovery and help promote recovery by removing barriers and obstacles to recovery through serving as a personal guide and mentor for people seeking recovery.

Your responses to this questionnaire will help us determine whether the RecoveryCorps Coach Position will be a good fit for you. Thank you for taking the time to respond thoroughly and accurately.

Name *
Your answer
Mailing Address *
Your answer
Town *
Your answer
Zip *
Your answer
Are you at least 21 years of age? *
Email address *
Your answer
Phone number *
Your answer
1. Are you a graduate of a CCAR-approved Recovery Coach Academy? (Not required to become a RecoveryCorps Service member. If no, skip to #4) *
2. If so, where and when did you attend your training?
Your answer
3. If so, have you been actively coaching since graduation from the Recovery Coach Academy you attended?
4. Are you available to begin service the week of September 24th, with a full-time, in-person AmeriCorps Orientation and Recovery Coach Academy in Ellsworth from Sept 24 - 28? *
5. If you answered “no” to question #4, are you available to begin service the week of October 15th, with a full-time, in-person AmeriCorps Orientation and Recovery Coach Academy in Ellsworth from Oct 15 - 19?
6. What Counties are you interested in serving in? (Check all that apply) *
Required
7. Are there specific service site(s) you interested in serving at?
Your answer
8. Are you interested in a full-time or part-time position? (Check all that apply) *
Required
9. Why do you want to be a RecoveryCorps Coach? *
Your answer
10. What experiences make you particularly well qualified to become a RecoveryCorps Coach? *
Your answer
11. We recognize all paths to recovery. Do you believe that there are multiple pathways to recovery? (Yes or No and please explain.) *
Your answer
12. Are you willing to be open minded about supporting people who want to follow alternative approaches to recovery, some that you may not have experience in? (Yes or No and please explain.) *
Your answer
13. RecoveryCorps Coaches and Recovery Allies need personal support. Please describe your personal recovery path and/or support system. *
Your answer
Law enforcement background checks are conducted on all applicants of the RecoveryCorps program. Please know that a past conviction will not necessarily prohibit an applicant from becoming a RecoveryCorps member, as we have confidence in a person’s ability to turn his or her life around. The mission of our RecoveryCorps program is to provide the highest quality coaching experience for people seeking, or in recovery. It is of primary importance that we ensure the safety of all program participants. While responding to these questions is not required, we appreciate your honest answers.
14. Do you have any pending criminal charges?
15. Are you currently under the supervision of any probation or parole department?
16. If yes, what are your conditions of release and when will they end?
Your answer
17. Have you ever been convicted of a sex offense?
18. Have you ever been convicted of murder?
19. Have you ever been convicted of a crime that involved violence?
20. If yes, what was the charge and when did this happen?
Your answer
21. The reputation of our RecoveryCorps program hinges on the community’s perceptions and experience with their RecoveryCorps Coaches and those involved with the program. With that in mind, are there any other charges or convictions from your past that we should be aware of?
Your answer
22. If yes, what was the nature of the charge and when did this happen?
Your answer
If you have not yet done so, please fill out an AmeriCorps application (required part of the process), by going to: https://my.americorps.gov > create an account > search for “Maine RecoveryCorps”
Your answer
Thank you for your interest in the RecoveryCorps Program. We will be in touch soon. Please contact Sandie Dubay at 207-667-7171 or sandie@healthyacadia.org if you have any questions.
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