Staff Member Applicant Information :

First and Last Name

Title

Institution/Agency

Address

City

State

ZIP Code

Daytime Phone

FAX

Email

Student Member Applicant Information

First and Last Name

School or College Program

Length of Time Enrolled

Address

City

State

ZIP Code

Daytime Phone

FAX

Email

School or College Program Information (to be completed by Staff representative):

Please choose the option that best describes your institution:

Highschool that recieves some public funding Highschool that receives no public funding Public College or University Private College or University Other

If you selected 'Other', please describe below:

Does your school or college program offer services designed for students recovering from chemical dependency?
Yes
No (If not, you may not apply for institutional membership, but you are eligible for Associate Membership.)

Does your program operate primarily as a treatment center or mental health agency?
Yes (If so, you may not be eligible for institutional membership. Please contact the ARS director for more information.) 
No 

What year did your school program open?    

If your school is a high school, does your school require all students to be in recovery from chemical dependency AND to be sober and working a program of recovery (as determined by the student and the school)?
Yes
No (If not, you may not be eligible for institutional membership. Please contact the ARS director for more information.) 

If your school is a college program, does your program require all recovering students to be sober and working a program of recovery (as determined by the student and the college program)?
Yes
No (If not, you may not be eligible for institutional membership. Please contact the ARS director for more information.)

Does your school offer academic courses for which students receive credit towards a high school or college diploma?
Yes
No (If not, you may not apply for institutional membership, but you are eligible for Associate Membership.)

Does your school or college program provide services which assist a student in making the transition into a college, a career, or another school?
Yes
No (If not, you may not apply for institutional membership, but you are eligible for Associate Membership.)

Does your school or college program have a plan in place to handle the therapeutic and crisis needs of students?
Yes (If yes, please attach a description of this plan to an email to the ARS director.  If you have a counselor on-staff, a description of his or her credentials will suffice.) 
No (If not, please describe in an email to the ARS director how the therapeutic needs of your students are handled.  If no out-source plan is currently in-place, you will be given six months to submit one before your membership is cancelled.)