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 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

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 liz@pmhca.org 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:

Date

* 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:

Date

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

* 12. Date of Certification:

Date

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