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CMPSS Specialization for Peer Services in Crisis Care Pre-Registration Form

To fully register, you must complete each response

Please note that the registration will not be complete unless all questions are fully answered. We cannot guarantee your enrollment by completing this pre-registration. You will be placed in an order of priority, based on the number of individuals who both pre-register and who complete the full registration when requested to do so. Some individuals may likely be waitlisted and or requested to pre-register for a later date. Thank you for your patience.
1.What is your full name?(Required.)
2.Are you a certified Medi-Cal Peer Support Specialist (CMPSS) in California?(Required.)
3.What is your certification number?
4.Choose your training dates. Please note that the class size is limited to 17 participants in order to keep the learning experiential and supportive. This is a 40 hour training and meets Monday through Friday, from 8:30 am until 12:30 pm. Participants may not miss more than 6 hours in total.(Required.)
5.What is the best phone number to contact you?(Required.)
6.What is your email address?(Required.)
7.Participating in this training program requires you to have a lived recovery experience defined as personal experience of being a consumer of mental health or substance use disorder services, or as a parent, family member or direct care supporter of someone who does.  Do you have a lived recovery experience, as defined here?(Required.)
8.What is your employment or volunteer status?(Required.)
9.What is the title of your employment/volunteer position?(Required.)
10.Name of your county(Required.)