Step 1 of 2 50% What is your gender? Male Female Transgender None of these 2. What is your race? (Select one or more): American Indian or Alaska Native Asian Hispanic or Latino Native Hawaiian or Other Pacific Islander White 3. What is the highest degree you have received? (Select one): Less than high school High school diploma or equivalent (GED) Some college, but no degree Associate’s degree Bachelor’s degree Master’s degree Doctor of Pharmacy (PharmD) Doctor of Medicine or Doctor of Osteopathy Other Doctoral degree or Equivalent (e.g., PhD, EdD, DPT) Other 4. What is your primary profession? (Select one): Addictions Professional Psychiatrist Psychologist Counselor Social Worker Recovery specialist Peer professional Criminal justice/law enforcement professional Community health worker Health educator Educator Public or Business Administrator Researcher Physician Physician Assistant Nurse Pharmacist Advance Practice Registered Nurse Nurse Practitioner Nurse Midwife Dentist Student Full-time Student Part-time (not working) Student Part-time (working) Other 5. What is your principal employment setting? (Select one): Substance use disorder treatment program Substance use disorder prevention program Community recovery support program Group home Transitional/supported living facility Mental health clinic or treatment program (Community mental health program) Community health Primary care Solo practice Group practice Hospital FQHC hospital State psychiatric hospital Skilled nursing facility Criminal justice/corrections (court, prison, jail, prison/probation, TASC) Military/VA Higher education setting Elementary or secondary education setting Community-based organization (including faith-based organizations) Community coalition Other 6. What is the ZIP Code of your principal employment setting? ZIP Code 7. How satisfied were you with the overall quality of this event? Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied 8. I expect this event to benefit my professional development and/or practice. Strongly Agree Agree Neutral Disagree Strongly Disagree 9. I will use the information gained from this event to change my current practice. Strongly Agree Agree Neutral Disagree Strongly Disagree 10. I would recommend this event to a colleague. Yes No Personal Code (please use uppercase letters):First letter in mother’s name: First letter in mother’s name:First letter in mother’s maiden name: First letter in mother’s maiden name:First digit of Social Security number:Please enter a number from 0 to 9.First digit of Social Security number:Last digit of Social Security number:Please enter a number from 0 to 9.Last digit of Social Security number: CEU Completion/Issuance FormWould you like a certificate of completion?(Required) Yes No Email(Required) Name(Required) I confirm I attended:(Required) The Entire Conference Part of the Conference Please select sessions attended for issuing CEUs.(Required) Day 1- Welcome & Kick-Off Day 1- Keynote Day 1- Recovery Advocacy in the Age of COVID-19 or Grief While In Recovery Day 1- Multiple Pathways of Recovery or Creating a Healing Community Day 1- Plenary Panel: Whats the Difference? Day 1- Survivor Insights or "We Do More than Listen" Day 1- Recovery Messaging or RCO Best Practices Day 1- Closing Day 2- Welcome & Kick-Off Day 2- Keynote Day 2- Building and Maintaining a Successful Recovery Community Organization (RCO) or Grant Writing Tips & Tools Day 2- Justice Involved or Recovery Rejection Day 2- Plenary Panel: This is Us! Day 2- Unicorns, Rainbows and Glitter Ponies or CRAFT Connect Day 2- Basics of Successful Fundraising or Disaster Looming Day 2- Closing
