Workforce Interest Form

County *

Are you interested in *

Are you interested in... *

Age Group *

Are you currently in recovery for a substance use disorder?

Please select all that you are interested in

Juvenile Justice (for youth 14-20, referred by Juvenile Court or Probation Officer)
Personal Responsibility Education Program (PREP); available in select counties in Northeast Ohio
Bridges Out of Poverty workshops; available in select counties in Northeast Ohio
R Rules curriculum programs

Name *

First

Last

Birthday *

Phone *

Email *

Zip Code *

How did you hear about our program? *

If other, please explain *