Organization Information

Your name(Required)

First Last

Your email address(Required)

Your phone number(Required)

Your role within the organization(Required)

E.g. "president", "executive director", etc.

Organization name(Required)

Organization address(Required)

Street Address Address Line 2 City State ZIP Code

Organization email address(Required)

Organization phone number(Required)

Organization website

EIN(Required)

Please provide your EIN (federal tax ID number).

Articles of incorporation(Required)

Max. file size: 16 MB.

Please upload a copy of your organization's articles of incorporation.

Sample-PDF-01-10.pdf

Business or 501c3 letter(Required)

Max. file size: 16 MB.

Please upload a copy of your organization's state business registration or 501(c)(3) designation from the IRS.

Sample-PDF-02-7.pdf

Staff directory(Required)

Please list your organization's current staff, including names and titles.

Insurance verification(Required)

Drop files here or

Max. file size: 16 MB.

Please upload a copy of any relevant insurance certificate(s).

Not Enrolled

	Organization Information
	Recovery Culture, Ethical Framework and Principles
	Staff Development
	Peer Leadership Development
	Operations, Systems and Financial Management
	Governance