Peer Certification Reimbursement Application

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

Question Title

* 1. Full Name:

Question Title

* 2. Home Address:

Question Title

* 3. City, State, Zip Code:

Question Title

* 4. Phone Number:

Question Title

* 5. Email Address:

Work Information
As it relates to your Peer Recovery Specialist Certification

Question Title

* 6. Organization/Agency:

Question Title

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

Yes

Question Title

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

OORP (Opioid Overdose Response Program)

STAR (Support Team for Addiction)

MWRAP (Maternal Wraparound Support Services)

LEARPP (Law Enforcement Assisted Addiction & Recovery Referral Program)

IRTS (Intensive Recovery Treatment Services)

CPSAI (Child Protection Substance Abuse Initiative)

Recovery Center

Recovery Support on College Campuses

Recovery High Schools

Recovery Housing

Treatment Center - Continued Care & Recovery Support

Other (please specify)

Question Title

* 9. Supervisor Information

Supervisor First Name

Supervisor Last Name

Supervisor Email Address

Supervisor Phone Number

Question Title

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

3-Day Ethics

5-Day CCAR Recovery Coach Academy

Other (please specify)

Reimbursement Information

Question Title

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

CPRS (Certified Peer Recovery Specialist)

NCPRSS (National Certified Peer Recovery Support Specialist)

Question Title

* 12. Please provide your certification number:

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

Question Title

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

Yes

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

Question Title

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

PDF file types only.

Choose File

Question Title

* 15. Copy of your certification:

PDF file types only.

Choose File

Question Title

* 16. 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.