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)? * Address of your organization 9. Street address * City * County * State * ZIP * 10. Organization website * 11. Please provide your organization’s mission statement: * 12. Please provide your organization’s vision statement: * 14. Please describe how your organization engages in the three core principles of a recovery community organization a. Recovery vision: Recovery community organizations focus on the reality of long-term recovery from addiction to alcohol and other drugs. The recovery community organization, its leaders, and members have a singular goal: enhancing the quantity and quality of support available to people seeking and experiencing long-term recovery from addiction. * b. Authenticity of voice: RCO’s represent the interests of the recovery community. A guiding principle is self-governance, mutual aid, and support. RCO’s are developed to serve communities, with leadership by and for community members. * c. Accountability to the recovery community: RCO’s credibility and effectiveness depends on their ability to be accountable and responsive to the community they work in and with, this means being an independent, stand-alone nonprofit organization, where they can manage their relationships with other organizations. Independence allows a recovery community organization to bridge the gaps between the recovery community and government agencies, the criminal justice system and the larger network of health and human services providers. The recovery community organization’s real strength is drawn not from its links to other service organizations but from the authentic voice of the individuals in the recovery community who relate to and actively support it. * 15. How many paid staff members does your organization have? * 16. 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 of Directors, including the number of individuals on your Board. * 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: Educate the public, policy makers, service providers, and the media about the reality of recovery offers hope and dispels myths and pessimism about the power and reality of long-term addiction recovery. This strategy also draws attention to the social and policy barriers facing people in and seeking recovery. * b. Recovery Advocacy: Addressing the public policy barriers that keep people from sustaining their recovery long term. Advocacy is aimed at ending the punishment and incarceration of people for their status as people with histories of addiction. * c. Peer and other recovery support services: Deliver a variety of peer recovery support services and places to deliver those services which include recovery coaching, telephone recovery support services, all-recovery meetings, and community-wide safe social activities, workshops, meetings, and resource connections. * 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 *
Fiscal agent agreement if operating under an existing 501 (c)(3).
Signed and notarized affidavit stating the board consists of 51% of its members identifying as individuals in recovery from substance use. The affidavit must be signed by the organization’s Director stating the Board of Directors meets the 51% in SUD recovery and must be signed by the applying organization Director and certified notary. *
Verification if Accreditation from The Council on Accreditation of Peer Recovery Support Services (CAPRSS) (if applicable, ONLY applies to organizations accredited by CAPRSS).
Section 4: Application submission