Overdose Prevention Ambassador

Overdose Prevention Ambassador

Initial Application
Personal Information
Name*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Languages fluently spoken in addition to English
Gender*
Please select your highest level of education*
Why are you interested in becoming an overdose prevention ambassador?*
What previous knowledge or experience do you have with harm reduction, naloxone, preventable drug overdoses?*
Who would be the primary audiences you would want to target with ODP trainings?*
What is your affiliation to recovery?*

Person in recoveryFamily memberProviderAlly
Availability

Please select your general availability for community outreach and trainings*

Please indicate highest number of hours you are able to work in a day*
Maximum number of hours you're available per week?*
Next Step
All Overdose Prevention Ambassadors must complete an overdose prevention training and orientation with Foundation for Recovery. When you submit your application you will be sent an automatic email with a link to the dates and times of the next training and orientation for ambassadors.

While we review your application, please register for one of our upcoming training and orientation session. If you have any questions, please contact us at training@forrecovery.org or (702)257-8199
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Personal Information