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Individual Account

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Contact

Professional Information

Address

Account Information

Pronouns

Organization Account

Organization Details

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Tip: Use a generic email such as info@company.com so that the account is not tied to an individual’s email address.

Address

Account Information

Select the most appropriate continuum of care for your organization’s work

Municipality Account

Municipality Details

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Address

Account Information

Select the service areas you are interested in (select all that apply)*

Prevention Harm reduction Access to care Recovery supports Trauma, grief, and family supports Other

State Agency Account

State Entity Details

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Address

Account Information

Select continuum care area(s) of focus (select all that apply)*

Prevention Harm reduction Access to care Recovery supports Trauma, grief, and family supports Other

In which region of the Commonwealth are you located? *

Please refer to this link for definitions. Select where you live or work – whichever is more applicable.

What's your motivation for joining the Mosaic Community Hub? (select all that apply) *

Assist someone navigating substance use, treatment or recovery supports Build connections and collaborations Seek education and knowledge sharing opportunities Gather more information on opioid settlement fund spending Share my experience as a person with living or lived experience with substance use Honor a loved one lost a loved one to overdose Other

Other Motivation

How did you find out about the Mosaic Community Hub? (select all that apply) *

RIZE Massachusetts Foundation Mosaic Opioid Recovery Partnership MA DPH Bureau of Substance Addiction Services Organization received a grant from RIZE or Mosaic Marketing email Social media Network referral Other

Network Referral Details

Other Discovery Method

In which region of the Commonwealth is this organization located? *

Please refer to this link for definitions.

What's your motivation for joining the Community Hub? (select all that apply)*

Assist someone navigate substance use, treatment or recovery supports Build connections and collaborations Seek education and knowledge sharing opportunities Gather more information on opioid settlement fund spending Share my experience as a person with living or lived experience with substance use Honor a loved one lost a loved one to overdose Other

How did you find out about the Community Hub? (select all that apply)*

RIZE Massachusetts Foundation Mosaic Opioid Recovery Partnership Organization received grant funding from RIZE or Mosaic MA DPH Bureau of Substance Addiction Services Marketing email Social media Network referral Other

Network Referral Details

Other Discovery Method

In which region of the Commonwealth are you located? *

Please refer to this link for definitions.

What's your motivation for joining the Community Hub? (select all that apply)*

Assist someone navigating substance use, treatment or recovery supports Build connections and collaborations Seek education and knowledge sharing opportunities Gather more information on opioid settlement fund spending Share my experience as a person with living or lived experience with substance use Honor a loved one lost a loved one to overdose Other

How did you find out about the Community Hub? (select all that apply)*

RIZE Massachusetts Foundation Mosaic Opioid Recovery Partnership Organization received grant funding from RIZE or Mosaic MA DPH Bureau of Substance Addiction Services Marketing email Social media Network referral Other