Recovery Ally Training Recovery Ally Training Curriculum Request Form Name* First Last Email* Are You Affiliated with UConn?* Yes No Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about our training?* Website Social Media Daily Digest Personal Referral Professor/Teacher Recommendation Other How did you hear about our training?* Who is the audience for the training?* Would you like to be included on a mail list to receive revisions we may make to the training in the future? Yes No Permissions* I will not charge a fee for participants to attend training using this program. (Exceptions: as part of enrollment at a school/college where tuition is charged or part of a larger conference where a registration fee is charged.) I will honor the citations as listed if I decide to modify the program to suit the needs of my audience. NameThis field is for validation purposes and should be left unchanged.