Section 1: About the Organization 1. Organization Name * 2. Name of Executive Director * 3. Email address of Executive Director * 4. Phone number of Executive Director: *
Please identify designated individual from the organization to receive and respond to correspondence regarding RCO application.
5. Name of individual completing application: * 6. Title/position of individual completing application * 7. Email address of individual completing this application * 8. Email address for application follow-up * Is your organization accredited by the Council on Accreditation of Peer Recovery Support Services (CAPRSS)? * Is your organization a certified member of the Recovery Café Network? About your organization 1. Street address * City * County * State * ZIP * 2. Organization website * 3. Please provide your organization’s mission statement: * 4. Please provide your organization’s vision statement: * 6. Please describe how your organization engages in the three core principles of a recovery community organization * Core Principles
Recovery vision – Focuses on long-term recovery from addictions, enhancing quality and quantity of recovery support services available to the community, mobilizing individuals and community resources to promote recovery.
Authenticity of voice – Represents the interest of the local or statewide recovery community, supports self-directed recovery, mutual aid including all pathways of recovery, developed by and for the recovery community, with a minimum of 51% of board members identifying as individuals in recovery from addiction.
Accountability to the recovery community – The organization is accountable and responsive to the community they serve, autonomous non-profit organization, independent in governance, drawing strength from the authentic voice of the recovery community. 7. How many paid staff members does your organization have? * 8. How many volunteers does your organization have? * Section 2: Governance 1. What is the current non-profit status of your organization? (Select the one that best applies) * 2. Please describe the makeup of your board including the number of individuals on your board. *
(It can be an advisory board or board of directors)
3. What percentage of your board members identify as being in recovery from substance use disorder? * Section 3: Activities and Programs 1. Please describe in detail how your organization engages in one or more of the three core strategies of a recovery community organization (core strategies listed in the RCO self-assessment). a. Public Education: * b. Recovery Advocacy: * c. Peer and other recovery support services: * 2. Does your recovery organization provide clinical treatment services? * 3. Please describe how your organization engages members of the recovery community in service and program development: * 4. Does your organization provide leadership opportunities and/or professional development for members of the recovery community, including staff and volunteers? 5. Does your organization support multiple pathways of recovery? * 6. Does your organization provide recovery support services to all individuals regardless of their pathway of recovery? * Required Attachments for Recovery Community Organization Certification 501(c)(3) Determination Letter *
Signed affidavit stating the board consists of 51% of its members identifying as individuals in recovery from substance use. *
Section 4: Application submission