CMPSS Justice Involved Specialization- Pre-Registration Form

To fully register, you must complete each response

This dynamic 40-hour, skill-based and wholly interactive course will provide participants with an understanding of how to provide person-centered support to individuals with justice involvement experiences. Participants will apply advanced skills in various peer support service scenarios, understand how to work with and within the justice system, identify the best support for individuals at each step in the Sequential Intercept Model (SIM), explore guidelines for individual, professional, and system advocacy, apply ethical standards when providing support, understand the importance of individualized support using the Risk-Needs Responsibility Model, and practice a trauma informed approach.

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.

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* 1. What is your full name?

First Name

Last Name

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* 2. Choose your training dates. Please note that the class size is limited to 14 participants in order to keep the learning experiential and supportive. Also, please check back for updated schedules, as more and more people seek this specialization.

January 3 through January 14, 2024

February 5 through February 16, 2024

February 26 through March 8, 2024

March 11 through March 22, 2024

April 1 through April 12, 2024

June 3 through June 14, 2024

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* 3. What is the best phone number to contact you?

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* 4. What is your email address?

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* 5. In a few words, please describe your interest in this training program.

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* 6. 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?

Yes

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* 7. Do you have a CalMHSA scholarship? If you do not have a scholarship, we recommend that you apply at: https://www.capeercertification.org/certification-scholarships/

Yes

I have applied and its pending

I do not know.

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* 8. What is your employment or volunteer status?

Yes. I am employed part time (20 hours or less per week).

Yes. I am employed full time (36-40 hours per week).

Yes. I am an unpaid volunteer

No. I am unemployed and I do not currently volunteer.

CMPSS Justice Involved Specialization- Pre-Registration Form

To fully register, you must complete each response

Question Title

* 1. What is your full name?

Question Title

* 2. Choose your training dates. Please note that the class size is limited to 14 participants in order to keep the learning experiential and supportive. Also, please check back for updated schedules, as more and more people seek this specialization.

Question Title

* 3. What is the best phone number to contact you?

Question Title

* 4. What is your email address?

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* 5. In a few words, please describe your interest in this training program.

Question Title

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* 7. Do you have a CalMHSA scholarship? If you do not have a scholarship, we recommend that you apply at: https://www.capeercertification.org/certification-scholarships/

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* 8. What is your employment or volunteer status?

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* 9. What is the title of your employment/volunteer position?

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* 10. What is the name of your employer & program or volunteer placement site?

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* 11. Name of your county