This individual requesting a recommendation is applying for admission to the Peer Recovery Support Specialist Certification program.  We are interested in obtaining all information you think would be helpful in assessing this applicant's qualifications for admission.  Consistent with the Family Rights and Privacy Act of 1974, this form will not become part of the applicant's permanent record and will not be available to the applicant.

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* 1. For whom are you completing this recommendation?

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* 2. How long have you known the applicant?

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* 3. In what capacity have you known the applicant?

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