CA Utah H&I Application H&I Application Name * Phone No. * Email * Sobriety Date * Availability - Days of the Week (Check all that apply) * Monday Tuesday Wednesday Thursday Friday Saturday Sunday Availability - Preferred Times (Check all that apply) * Morning (before noon) Afternoon (12:00 PM - 5:00 PM) Evening (5:00 PM - 9:00 PM) Late Evening (9:00 PM and beyond) Have you previously facilitated or participated in C.A. meetings? * Yes No How often are you able to commit to leading/attending C.A. meetings at treatment centers? Weekly Bi-Weekly Monthly OtherOther Additional Information Is there anything else you'd like us to know about your interest in taking C.A. meetings into treatment centers? Captcha Submit If you are human, leave this field blank.
