Maine – Registered Peer Recovery Coach Application Registered Coach Application Date Of Application Date of Birth * Gender * Applicant Information First Name * Last Name * Address * Address House Number & Street House Number & Street Address Line 2 Address Line 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal County * Phone * Email Address * If we need to contact you regarding your application, please indicate your preference: * Email Phone Education/Training Recovery Coach Academy * Location/Date Recovery Coach Academy * Trainer Ethical Considerations for Recovery Coaches * Location/Date Ethical Considerations for Recovery Coaches * Trainer YOU MUST INCLUDE COPIES OF YOUR CERTIFICATES FOR RECOVERY COACH ACADEMY AND ETHICAL CONSIDERATIONS FOR RECOVERY COACHES * Drop a file here or click to upload Choose File Maximum file size: 2MB Attestation Statement Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. I attest that I am an individual or affected other in recovery (see page 3 of the MRCCB Applicant Manual) and work each day to support my life in recovery within the following four dimensions: Health * I practice a pathway of recovery for making informed, healthy choices that support my physical and emotional well-being. (For example, abstaining from addictive substances, relationships, or other addictive processes and/or behaviors.) Home * I have a stable and safe place to live. Purpose * I conduct meaningful daily activities and have the independence, income, and resources to participate in society. Community * I have relationships and social networks that provide support, friendship, love, and hope. Signature * Clear Date If you are human, leave this field blank. Continue - Code of Ethics