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Mobilize Recovery 2026 Scholarship Application

First Name

Last Name

Email

Mobile number

Your Address


Tell us a little bit about yourself...

Your Date of Birth

Your Race/Ethnicity

Your Race/Ethnicity

Your Primary Language

Additional Languages Spoken

Are you a US Veteran

Are you a US Veteran

Are you a person with a disability?

Are you a person with a disability?

Your Professional Background & Experience

Primary Recovery Status

Primary Recovery Status

Which sector of the recovery ecosystem do you primarily represent?

Which sector of the recovery ecosystem do you primarily represent?

Are you currently employed?

Are you currently employed?

Are you a student?

Are you a student?

Do you hold any professional certifications or licenses? (e.g., LCSW, CPRS, MD, RN, etc.)

Have you attended a Mobilize Recovery in-person event in the past?

Have you attended a Mobilize Recovery in-person event in the past?

Have you attended the Global Exchange Conference (GXC) in the past?

Have you attended the Global Exchange Conference (GXC) in the past?

Your Narrative & Organizing Impact

What is your vision for the recovery community over the next 5 years, and how do you believe the Mobilize Recovery track at GXC 2026 will help you achieve it?

Please provide a concrete example of a community organizing or mobilization effort you led or participated in recently.

List up to 5 organizations or grassroots efforts you have worked with in the last 3 years and your specific role.


Partnership, Programming & Digital Influence

Experience Checklist: (Select all that apply)

Experience Checklist: (Select all that apply)

Are you interested in being considered as a speaker, panelist, or workshop facilitator for the Mobilize Recovery track?

Are you interested in being considered as a speaker, panelist, or workshop facilitator for the Mobilize Recovery track?

Are you currently involved with any of our national partners?

Do you support all pathways of recovery, including MAT/MAR and Harm Reduction?

Do you support all pathways of recovery, including MAT/MAR and Harm Reduction?

Commitment & Logistics

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Upon returning from GXC 2026, how do you plan to share the training and resources gained with your local community?

Does your current employer/organization support your attendance for professional development?

Does your current employer/organization support your attendance for professional development?

Anything else you want the selection committee to know?

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