Peer AcademyTraining Application

August 18 – August 22, 2014

  • Please be aware that the Peer Academy Training is a one week (40 hour) intensivetraining.
  • Trainings will be held from 9:00 a.m. – 5:00 p.m. each day.
  • In order to receive a certificate of completion, trainees need to plan to be present and participate on ALL scheduled days and hours.

Please complete each section fully and remember to print clearly

Participant Contact Information

Name:______

Address: ______

Email: ______

Contact Number: (_____)_____- ______Date of Birth: _____/_____/_____

Alternate Contact Information

Name: ______

Address: ______

Telephone Number: (_____) _____- ______

Are you currently employed as a peer support specialist? ______

What is the name of your employer? ______

If you are not currently employed as a peer support specialist, do you have an offer of employment pending? ______

PLEASE ANSWER ALL QUESTIONS BELOW

Additional sheets/space may be used if needed.

Qualifications:

  1. Can you identify yourself as a person who has received or is receiving services for amental health issue, addiction issue, and/or other personal challenge? Please explain:

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  1. Have you completed the WRAP (Wellness Recovery Action Planning) class or correspondence course? Do you have a WRAP plan? ______

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  1. What other recovery tools do you use in your daily life?

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  1. Describe what has been helpful in your recovery.

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The following questions will help the Review Committee to choosebetween multiple applicants so please answer all questions in full.

What does recovery mean to you? What factors are/were important in your own recovery? ______

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PeerSupportSpecialists are models of recovery for others. In what ways do you demonstrate recovery and its goal of a full and meaningful life in the community?

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Tell us how you use natural supports (i.e., peers, family, church, etc.).

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Please share why you are interested in Peer Support Services and the possibility of working as a Certified Peer Specialist.

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Please discuss where work fits into your current plans. Is working as aCertified Peer Specialist something that you are interested in doing right now, or are you interested in the training as a step on your career path?

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Please describe your current employment situation (paid or volunteer). If you’re not working, please describe how you spend your time.

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Describe what strengths you may bring to the position and what skills you feel you need to develop.

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The Peer Academy Training is an intensive training course built on interaction and the sharing of behavioral health/addiction or other personal challenge experiences. What will be your greatest challenge in attending Peer AcademyTraining and how will you address this challenge?

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Are there any accommodations that you might need in order to participate in the training (e.g., seeing eye dog, note taker, sign language interpreter)?

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We strongly encourage you to provide at least one letter of recommendation that you feel would be helpful. Please note your relationship to the person who wrote the letter. Such letters may be written by former or present employers, teachers, volunteer supervisors, clergy, or a staff member who has provided your services or treatment who might testify to your qualifications.

Name of person and relationship of person providing letter of recommendation:

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Note: If further information is needed to make a selection decision we will contact you by email.

How did you hear about this training? ______

By signing below, you certify that you understand the above information and, if selected, plan to be present and actively participate in Meridian / Smoky Mountain Center’s PEER ACADEMY TRAININGProgram. You further understand that all classroom and personal discussions are strictly confidential so that all class participants can benefit from the free exchange of experiences and ideas. You also understand that if you share information that indicates that you may be at risk of harm to yourself or others and/or know of a situation where someone is at risk of harm to themselves or others, the instructor will have a private discussion with the student about the situation and report this information as required by Ethical Standards of Conduct.

Applicant’s Signature: ______

Date: _____/_____/_____

While we anticipate that there will be many positions open to Certified Peer Support Specialists in the coming years, completing the Peer Academy Training is NOT a guarantee of employment. Should you choose to pursue certification as a Certified Peer Support Specialist, you will need to apply for positions that are available and utilize the necessary community supports for job seeking skills you may need.

Submittal of Application:

Please emailor fax your application to:

Torrie Justus ()

Fax: 828-631-9280

Additional Information regarding Becoming a Certified Peer Support Specialist can be found by going to:

Thank you for your application. Program participants will be chosen based upon the following qualifications:

-Be a current or former consumer of mental health and/or substance use disorder services

-Have a minimum of 1 year demonstrated recovery time prior to date of application

-Be at least 18 years of age

-Responses to application questions

-Timely submission of the application

PET Application

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