Developmental Disabilities • Mental Health • Substance Recovery Recipient Rights Training Test v2
Recipient Rights Training Test v2
Please fill out the form below. Fields marked with an asterisk * are required.
First Name: *
Last Name: *
Your Email Address: *
Repeat Email Address: *
Your Home Street Address: *
Apartment or Unit #:
Your City: *
Your 5-Digit Zip Code: *
Your Date of Birth: *  (MO/DAY/YEAR)
Your Driver's License Or State Issued ID# *
Your Core Provider: *
(or if independent their core provider)
Your Agency / Location:*
(or "Employer of Record" if independent)