New Jersey Prevention Network
Chemical Dependency Associate (CDA) Student Application

Please note: The information supplied populates your profile in our database. Please proofread carefully before submitting. Incomplete applications that do not meet this criteria cannot be processed.

Contact Information

PERSONAL

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If you do not live in NJ, pick the NJ county closest to your home.








WORK

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All communication is done via e-mail, so either a home or work e-mail address is required.







Clinical Supervisor's Information

Experience and Education

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How did you learn about the Chemical Dependency Associate (CDA) Program?

Student Statement

* In your own words, please tell us why you should be selected for the Training and Workforce Development Initiative Scholarship program. Include the reason(s) you desire a career in the addictions field and include how the course work will lead to your obtaining your CADC or LCADC.

If you are not CURRENTLY working at a DMHAS-licensed substance abuse treatment or mental health agency or a state psychiatric hospital, please explain what plans you are currently making to secure an internship in order to complete the required 3,000 experience hours needed for certification or licensure.(If you do not fully respond to this inquiry in your Statement, your Application will be delayed.)

Agreements

Summary Information