Rimrock Foundation - Teachers in residence application in addition to addiction treatment for alcohol dependency, compulsive gambling, meth and cocaine addiction, and anorexia or bulimia.

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overview

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inpatient

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outpatient

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adolescent services

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speciality:

-	new choices
-	court school
-	employee assistance
-	michel's house
-	sober housing
-	crisis stabilization

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TEACHERS IN RESIDENCE PROGRAM
Call (800)227-3953

Application

Items marked with a * must be completed to process the form.

Please DO NOT hit the ENTER key when filling out the form, or the form will be sent prematurely.

You may use the TAB key to move from field to field.

Name
Home Address
City
State
Zip
Email*
Home Phone
Work Phone
School Name
School Address
City
State
Zip
Position
Grade Level
Supervisor

Please briefly describe why you are interested in taking part in the Teachers In Residence Program.

Have you served on any school-based chemical dependency prevention/referral teams or similar projects? If so please describe the group and your role in it.

What previous chemical dependency education/training have you received?

Use this space to add any other relevant points you would like us to know when we review your application.

Submitting this form does not constitute an agreement on the part of Rimrock Foundation or the person submitting the form. All applications will be reviewed by the screening committee. Those chosen to participate in the program will then be notified.

Please press the "Submit Application" button only once,
and wait for the "Thank You" screen confirming your submission.

The information on this form WILL NOT be distributed outside of Rimrock Foundation for any other use.