Three Day Forensic Training - May 1, 2, 3, 2017

 
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Peer Support and the Criminal Justice System: Three-Day Training Application
May 1, 2, 3, 2017 8:30am - 4:30pm

Philadelphia Mental Health Care Corporation (PMHCC)
Wells Fargo Building, 23rd floor
123 South Broad Street
Philadelphia PA 19109
Phone: (215) 546-0300

Fee: $90.00
Lunch provided

This application is for the three-day Peer Support and Criminal Justice System Training.  Please note: the three-day training is only open to Pennsylvania residents who are Certified Peer Specialists (CPS) and Certified Recovery Specialists (CRS) with priority given to those who have lived experience in the criminal justice system.  By submitting this application, you are attesting that you are a certified peer specialist or certified recovery specialist. You must include a copy of your CPS/CRS Certificate with this application. Please email to liz@pmhca.org or fax (717-564-4708). You can also postal mail a copy of your CPS Certificate to Liz Woodley: 
PMHCA
4105 Derry Street
Harrisburg, PA 17111
717-564-4930

Applications must be received by April 7, 2017.

Applicants will be notified whether they were accepted into the training by April 13, 2017.

If you need accommodations to complete this application, contact Liz Woodley at liz@pmhca.org or (717) 564-4930 or 1-800-887-6422.
 

* 1. County of Residence:

* 2. Address

* 3. Date of Birth:

* 4. Current Employer or Volunteer Work:

* 5. Job Title (if applicable):

* 6. Is this a CPS position:

* 7. Is this a CRS position:

* 8. Check the primary population you work with:

* 9. Are you a Certified Peer Specialist?

* 10. Date of Certification:

* 11. Are you a Certified Recovery Specialist? (please provide copy of certification)

* 12. Date of Certification (please provide copy of your certification:

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