• Peer Support Specialist

    Application for Provisional Training
  • All sections of the form must be completed for the application to be accepted.

    Initial each section to showit was read in entirety and understood in content.

    The purpose of this form is to complete the screening process to begin the process to become trained as a Provisional Peer Support Specialist.

    The purpose of its contents is to assess applicant’s readiness and skillset to be an effective PC-PSS.

    Program Requirements: In accordance with the spoken goals around behavioral health recovery and re-entryreform, all applicants being considered for PC-PSS training are required at a minimum to:

    1. Be a self-identified individual (family member or consumer) with lived experience with behavioralhealth (mental illness and/or substance use and/or trauma)

    2. Or incarcerated for more than twenty-four months in addition to a behavioral health lived experienceworking toward re-entry.

    3. AND, the individual must possess the following skills:oLeadership skillsoReading comprehensionoWriting skillsoA strong knowledge specific to modeling recovery and wellnessoAn ability to learn to effectively document Medicaid Services provided to consumers

    4. AND an informal understanding of SAMHSA Core Competencies.

    • Principles & Values (all services provided must be)
      • Recovery-Oriented
      • Person-Centered
      • Voluntary
      • Relationship-Focused
      • Trauma-Informed
    • Core Competencies (all PC-PSS will work in the following manners)
      • Engage peers in a collaborative and caring relationship
      • Provide Support
      • Share lived experiences in recovery
      • Personalize peer support
      • Support recovery planning
      • Link to resources, services, and supports
      • Provide information about skills related to healt, wellness, and recovery
      • Help peers manage crises
      • Value communication
      • Support collaboration and teamwork
      • Promote leadership and advocacy
      • Promote growth and development

    This application is designed to demonstrate whether candidates meet the minimum criteria for this position. Because of that, please CHECK for complete and detailed sentences, spelling, and punctuation.

    The application must be completed without assistance. All Reasonable ADA Accommodations will bereviewed on a case-by-case basis.

    Initial Below that you understand the policies set forth for consideration of entering the Training to become a Provisional Peer Support Specialist.

  • PSS Application – General Instructions

    All sections must be completed for the application to be accepted.

    All questions and information must be provided to be considered for this PSS role. When answering the questions please use full sentences and your own thoughts, detailed content, understanding, and good writing skills. Please consider the following when answering these questions:

    The information you provide in this application will be shared with designated contractors for the purpose of improving and implementing effective training for the Peer Community in the State of Alaska.

    Complete the Application by Yourself: You may not have anyone help you fill out the application or edit your writing. No person, including a job coach, counselor, or case manager may aid you in this process. If you need a specific reasonable accommodation for a verified disability, or have questions about assistance, please contact the Peer Support Program Manager team and will make appropriate arrangements with you.

    1. Email Release: Unless otherwise indicated, upon certification your name will be included in local email distribution lists to communicate current job opportunities and other information specific to peer support. If you do not want your email address to be on these lists, there is a box on the last page to choose to opt out of the distribution lists.

    2. Required Education: Capability to read, write, communicate, and document the services provided effectively to your fellow consumers.

    3. Primary Language: Please list all languages you speak, read, and/or write fluently, beyond English

    4. Race: Like in all opportunities to provide services, Race is a voluntary disclosure and used for the sole purpose of understanding future needs.

    5. Current Situations: Like any other opportunity, verifiable work and volunteer experience are important, but also remember the value of your lived experiences when sharing in this application.

    6. Future Goals/Interests in PSS Work: Peer Work is largely funded through Medicaid at this point, so individuals wanting to train to go in the field and work will be a higher consideration than someone wanting to train for a personal interest. For what it takes to be a successful PSS, please place strong considerations around how it will impact you and your future should you take on this professional journey.

    7. Recovery: No one but you can say whether or not you are in recovery. This is something you must consider carefully. The PC-PSS role requires being able to help others and work consistently, in addition to a strong understanding of recovery concepts. Make sure to include skills and attitudes learned that help maintain your recovery. This area reflects recovery strengths and one’s current success in recovery.

    8. Leadership: While it takes many forms, PSS work requires it. Formal leadership experience includes participating on local committees, boards, or organizations. Other opportunities include facilitating groups or teaching classes. If you recognize participating in groups or classes as a source that’s helped develop your leadership skills, write about that. Share whatever you believe to have helped you achieve those skills. 

    9. Skills in Sharing Your Story of Recovery & Wellness: This answer should describe how comfortable you are in sharing your story, what kind of experience you have doing so, and how long you have been sharing your story. If you are just learning to be comfortable with disclosing, write about that. Don’t share the details of your story in this application. This means not sharing specific hospitalizations, medications, or therapy. Applicants who are comfortable talking about their lived experience with behavioral health and incarceration, in addition to more experience doing so will be stronger candidates.

    Initial Below that you understand these policies set forth regarding expectations as applied to the contents in this application as it applies to the Training to become a Provisional Certified Peer Support Specialist.

  • Your Demographic Information

  • Education


  • Eligibility: You are NOT eligible for the training unless you have lived experience with behavioral health (mental illness and/or substance use and/or trauma) and/or incarcerated for more than twenty-four months as a self-identified consumer or family member. If you do not have this background, please don’t apply for this training

  • Verify Your Eligibility

  • Potential Employment: This training is specific to individuals seeking volunteer and/or employmentopportunities in the PC-PSS role. Applications will be processed in order of receipt. As opportunities becomeavailable, the State of Alaska requires all applicants to complete a Criminal Background & Fingerprint Screening. Based on those results, you may require a Variance Request to continue with this opportunity.

    Please initial below to reflect your understanding of State of Alaska requirements to be considered for this position.

  • Your Employment History

  • This training is intended to prepare you to work and/or volunteer as a Provisional Peer Support Specialist in a Medicaid Behavioral Health Setting.

  • Applicants must be well grounded in their own Behavioral Health recovery for at least one year. This question is individual to each person but should indicate an understanding of the principles of recovery. Successful recovery does not mean one is “recovered.” It means that you are able to manage your symptoms effectively while participating in the quality of life you deem fulfilling and successful with future-oriented hope and aspiration.

  • Provisional Peer Support Specialists are expected to share their recovery stories with peers as part of their job duties when they'r employed or volunteering. Without sharing the full details of your recovery story.

  • PLEASE READ – Sign below to indicate that you have read and agree with the following statements:

    • I have completed this application myself with no assistance and understand that this is a test of myreading comprehension and writing skills.
    • I understand that training slots are limited and therefore submission of this application does not guaranteeadmission.
    • I understand that after completing the 40-hour classroom training, I must follow up with the State of Alaska to qualify for the certification.
    • I understand that the provisional training as a Peer Support Specialist does not guarantee employment.
    • I understand that a criminal background check may in some cases prevent employment with Behavioral Health Agencies
  • Clear
  •  /  /
    Pick a Date
  • For any questions regarding the Peer Support Program, please contact the Program Manager, Jenifer Galvan at jgalvan@acmhs.com or 907.444.3666.

  • ONLY SELECT ONE CLASS TO ATTEND. 

    If your application has more than one class selected or no class selected at all, it will be rejected.

  •  
  • Should be Empty:
Jotform Logo
Now create your own JotForm - It's free! Create your own JotForm