Recovery Ecosystems Conference Scholarship Application
Saturday, September 28, 2019 at The College of New Jersey, Brower Student Center 10am to 3pm

The Division of Mental Health and Addiction Services (DMHAS) are sponsoring scholarships for the first 100 qualifying Peer Workers supporting Peer services throughout NJ. Please submit your application below for consideration on or before 9/25/19. Please contact Cindymarie Dix with any questions cdix@preventionlinks.org 732-381-4100 ext 150.
First Name *
Your answer
Last Name *
Your answer
Mailing Address *
Your answer
City *
Your answer
State *
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Zip Code *
Your answer
County *
Your answer
Email Address *
Your answer
Confirm Email Address *
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Phone *
Your answer
Do you currently volunteer or work in the Peer Recovery Support field? *
Required
What agency do you work/volunteer at? *
Your answer
Peer Supervisor Name: *
Your answer
Peer Supervisor Email Address: *
Your answer
Peer Supervisor Phone: *
Your answer
Please select your active Peer Recovery certification(s): *
Required
Please select the active Peer Recovery Training(s) you have completed: *
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Which of the following programs do you currently work/volunteer for? *
Required
What is the primary initiative you currently work in? *
Do you currently work in the above-listed initiative full time, part time, per diem or volunteer? *
I agree to the following: *
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