0-Peer Support Professional Training Application

All sections of the form must be completed for the application to be accepted. The purpose of this form is to complete the screening process to begin the process to become trained as a Peer Support Professional. The purpose of its contents is to assess an applicant’s readiness and skills set to be an effective PSP. Please type or print clearly.

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

Name *

First Name Last Name

Address *

Street Address

City State / Province

Postal / Zip Code

Phone Number *

Please enter a valid phone number.

Email *

example@example.com

Have You Completed Your High School Diploma or GED? *

YES NO

Any additional education you'd like to be considered?

Please list any languages other than English which you speak fluently.

Please identify your Race from the selections below (OPTIONAL): *

African American Asian/Pacific Islander American Indian/Alaska Native Caucasian Hispanic/Latino I'd rather not answer Other

Please Select an Age group (OPTIONAL): *

18-24 25-39 40-59 60+ Prefer not to answer

Please select the Gender in which you identify (OPTIONAL): *

Male Female Transgender Non-Binary I'd prefer to not answer

Please select ONE class to attend *

PSP Application – General Instructions

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. 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: High School Diploma or GED

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 PSP 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 PSP 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, PSP work requires it. Formal leadership experience includes participating on local committees, boards, or organizations. Other opportunities include facilitating groups or teaching classes. 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.

By initialing below, I affirm my understanding of the contents addressed in the PSP Application - General Instructions. *

Applicant Initials

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

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

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

AND, the individual must possess the following skills:

Leadership skills
Reading comprehension
Writing skills
A strong knowledge specific to modeling recovery and wellness
An ability to learn to effectively document Medicaid Services provided to consumers

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 health, 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.

By initialing below, you affirm that you understand the policies set forth for consideration of entering the Training to become a Peer Support Professional. *

Applicant Initials

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. To qualify for this training, you must have significant experience in Behavioral Health Recovery. I agree that I meet this definition as a: *

A person who is receiving or has received Behavioral Health Services or been incarcerated in addition to Behavioral Health Services An immediate family member of one who has received OR been incarcerated in addition to Behavioral Health Services I meet both of the above definitions

Please describe how you meet the identified eligibility standards for lived experience with Behavioral Health Recovery. *

Potential Employment: This training is specific to individuals seeking volunteer and/or employment opportunities in the PSP role. Applications will be processed in order of receipt. As opportunities become available, 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. By initialing below, I affirm that background barriers may arise, and I am responsible for moving forward in the Variance Process to continue such opportunities. *

Applicant Initials

I am currently employed *

YES NO

I currently volunteer *

YES NO

I currently provide peer support services *

YES NO

Place of Employment/Volunteer Site

Program Name

Position Title

Site Phone Number

Please enter a valid phone number.

This training is intended to prepare you to work as a Peer Support Professional in a Medicaid Behavioral Health Agency. What are your future goals upon completion of this training? *

Successful applicants will demonstrate that they have been well-grounded in their own Behavioral Health Recovery for at least one year; have qualities of leadership including experience with governance, advocacy, creation, implementation or facilitation of peer-to-peer groups or activities. Why are you interested in becoming a peer support professional? *

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 & aspiration. Have you or your family been in Behavioral Health recovery for at least one year? Describe how you know you are in recovery and how you stay in recovery. *

Peer Support Professionals are expected to share their recovery stories with peers as part of their job duties when they’re employed or volunteering. Without sharing the details of your recovery story. What can you share about yourself to help a consumer you might serve? *

Select below if you would like to be removed from future emails related to peer counseling, training, continuing education, certifications, and employment.

Please remove me from your email list

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 my reading comprehension and writing skills.
I understand that training slots are limited and therefore submission of this application does not guarantee admission.
I understand that by completing the State of Alaska approved 40-hour classroom Pre-Certification training, I am eligible to apply for formal Certification through Alaska Commission on Behavioral Health Certification.
I understand that this training as a Peer Support Professional does not guarantee employment.
I understand that a criminal justice background check may in some cases prevent employment with Behavioral Health Agencies.

Date of Application Completion *

Date

Signature *

Clear