Mental Health Professional & Educator Application

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N/A if not applicable, identify if student or candidate
We will only use your number to reach out to you in the context of this application.
Focus *
Any applicable credentials, .pdf or .doc/docx
3 minutes max, a simple introduction and a few highlights about your lived experience

I do hereby authorize and consent to the use of the video/audio recording of myself, by the CRC Recovery Foundation, Inc.’s Living Skills in the Schools Program (hereinafter “LSIS”) in connection with LSIS’ search for presenters.

​I understand that no monetary consideration shall be paid to me by LSIS for the use of the above-described video/audio recording and that it will be discarded at the end of the 12-month required retention period for recruitment applications.

​I understand that LSIS staff intends to review the video/audio recording to help build its presenter roster, however, I understand that LSIS may choose not to utilize my services as a presenter.

​I declare that the above statement is true and correct, and that I give my consent of my own free will, signed by typing my full name in the field below.