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Certified Peer Support Specialist Virtual Training for ACT (ACT 201 CPSS) Pre-Qualification Survey for Approval to Register

All ACT 201 CPSS Virtual Trainings are from 10 a.m. - 2p.m.

Please complete and submit this survey to determine your eligibility to take ACT 201 CPSS Virtual Trainings. The survey must be completed 10 days before the training date to be considered for registration. You will receive email notification of your eligibility status. If you are approved to take the training, a registration link will be sent to you via email. 
1.First  & Last Name:(Required.)
2.Email (Please provide an accurate email address. This is the email address your registration link will be sent to if approved for ACT 201 CPSS):(Required.)
3.Select the ACT 201 CPSS Virtual Training(s) you wish to attend (if the training you select is sold out and you are approved, you will be contacted to select another training date.) Each training date covers a different topic. Participants may attend multiple trainings but will be asked to select one training if multiple dates sell out. Please see the training brochure for descriptions:(Required.)
4.Do you work for a PIHP/CMHSP?(Required.)
5.Name of PIHP/CMHSP:(Required.)
6.Do you currently work as an ACT Certified Peer Support Specialist or Parapro to provide services to adults with SMI on an Assertive Community Treatment team?(Required.)
7.What is your Team name and address?(Required.)
8.If you answered no to the question above, do you anticipate joining an Assertive Community Treatment team in the next six months?(Required.)
9.Have you completed ACT 101?(Required.)
10.I agree to follow CMHA's virtual participation guidelines.(Required.)
Thank you for completing the survey. Responses may take up to two weeks.