Three Day Training: July 30, 31 and August 1, 2018

Peer Support Within the Criminal Justice System: Three-Day Training Application
July 30, 31 and August 1, 2018 8:30am - 4:30pm

Wellspan Philhaven
283 S. Butler Road
Lebanon, PA  17103
Phone: 717-273-8871

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 intended for Certified Peer Specialists (CPS) and/or 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 or fax (717-564-4708). You can also postal mail a copy of your CPS Certificate to:
Liz Woodley 
4105 Derry Street
Harrisburg, PA 17111

Applicants will be notified whether they were accepted into the training by June 29, 2018.

If you need accommodations to complete this application, contact Liz Woodley at or 717-564-4930 or 1-800-887-6422.
Application Deadline: Friday, June 22, 2018

* 1. Address

* 2. County of Residence:

* 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: