Please complete and submit the following online application for the consideration and reimbursement of either the Certified Peer Recovery Specialist (CPRS) certification through the Addiction Professionals Certification Board of NJ (APCBNJ); the National Certified Peer Recovery Support Specialist (NCPRSS) through the National Certification for Addiction Professional (NCC-AP) credential application fee, or any applicable testing fees. Funding for scholarships is provided by the New Jersey Department of Human Services, Division of Mental Health and Addiction Services State Opioid Response grant. In order to be eligible for this reimbursement scholarship a person must be either working in or volunteering for an approved DMHAS funded peer initiative and have a valid certification.

For questions, please contact Janine Fabrizio at 732-367-0611 or Janine@njpn.org. 

Contact Information

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* 1. Full Name:

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* 2. Home Address:

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* 3. City:

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* 4. State:

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* 5. Zip Code:

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* 6. Phone Number:

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* 7. Email Address:

Work Information
As it relates to your Peer Recovery Specialist Certification

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* 8. Organization/Agency:

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* 9. Is your organization/agency DMHAS-licensed?

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* 10. Program you are currently working in (choose one):

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* 11. Supervisor Information

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* 12. Please select Peer Trainings you have completed with NJPN:

Reimbursement Information

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* 13. I am seeking reimbursement for (choose one):

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* 14. Please provide your certification number:

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* 15. Please provide your certification issue date:

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* 16. Please provide your certification expiration date:

NAADAC Membership Benefits:
-Over 145 hours of FREE CE hours (worth $2,175) through NAADAC's Online Webinar Series
-NAADAC CE Acceptance by Addiction Professionals Certification Board of NJ
-Access to NAADAC Career Center

For a full list of benefits, click here: https://www.naadac.org/membership-benefits

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* 17. Are you interested in applying for a NAADAC Membership Scholarship?

For consideration on the application, please upload a copy of the following documentation:

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* 18. Receipt(s) indicating payment was made for application fee and/or test fee:

PDF file types only.
Choose File

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* 19. Copy of your certification:

PDF file types only.
Choose File

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* 20. Completed W9 form. A blank copy of the W9 form can be found here: https://www.irs.gov/pub/irs-pdf/fw9.pdf

PDF file types only.
Choose File
Thank you for your submission.

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