Recovery Peer Support Specialist Training Application

What is Peers in Recovery Mentorship Program?

This program was created to increase and enhance the individual's access to training platforms, coaching and on the job experience needed to become a Certified Recovery Peer Specialist (CRPS) through the Florida Certification Board. The CRPS credential is for people who use their lived experience and skills learned in training to help others achieve and maintain recovery and wellness from mental health and/or substance use conditions. The CRPS credential designates competency in the domains of Recovery Support, Advocacy, Mentoring and Professional Responsibilities.

Individuals in recovery, known as Peers, will be able to establish connection, offer encouragement, empower, and inspire hope to individuals in treatment as "experts in recovery" with the enhanced knowledge and skill set offered through the ongoing coaching and training of this program.

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* 1. Contact Information

Full Name as you want it listed on your certificates

Personal email address- Recommended to be used for your NAMI membership and FCB application

Professional/ Work e-mail address

Home Street Address (to receive training materials)

City, State, Zip

Phone Number

Employer

Immediate Supervisors' name

Immediate Supervisors telephone # and e-mail

Date of Hire as a peer with a CFBHN contracted provider?

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* 2. Which Region/ Circuit do you reside in?

Circuit 6- Pasco, Pinellas

Circuit 12- DeSoto, Manatee, Sarasota

Circuit 13- Hillsborough

Circuit 20- Charlotte, Collier, Glades, Hendry, Lee

Circuit 10- Hardee, Highlands, Polk

Outside of the Suncoast region-

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* 3. Please indicate where you are in the process of obtaining your Certified Recovery Peer Specialist (CRPS) certification through the Florida Certification Board.

I have completed the standard application through the Florida Certification Board

I have completed the provisional application through the Florida Certification Board

I have not yet started my application and will need support with the application process

I am already certified as a Certified Recovery Peer Specialist through the Florida Certification Board

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* 4. In order to capture our applicant culture, please check any of the below boxes that you identify with.

I have been diagnosed with a mental illness

I have been diagnosed with a substance use disorder

I have been diagnosed with a co-occurring disorder (mental illness and substance use disorder)

I am a family member/partner to an individual that has been diagnosed with a mental illness

I am a family member/partner to an individual that has been diagnosed with a substance use disorder

I am a family member/partner to an individuals that has been diagnosed with a co-occurring disorder (mental illness and substance use disorder)

Other (please specify)

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* 5. Please indicate your desired endorsement (Check all that apply)

Adult (A): Lived experience as an adult in recovery for a minimum of 2-years from a mental health and/or substance use condition.

Family (F): Lived experience as a family member or caregiver to another person who is living with a mental health and/or substance use condition.

Youth (Y): Are currently between the ages of 18 and 29 at the time of application and have lived experience as a person who, between the ages of 14 and 25 experienced a significant life challenge and is now living a wellness and/or recovery oriented lifestyle for at least two years.

Veteran (V): Lived experience as a veteran of any branch of the armed forces who is in recovery for a minimum of 2-years from a mental health and/or substance use condition.

Demographics
Please answer as many of the questions below as you are comfortable with to help us learn more about the participant in this application. Participation is voluntary in answering these questions.

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* 6. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

Older than 65 years old

Prefer not to say

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* 7. What is your gender?

Female

Male

Non-binary/third gender

Agender

Cisgender-Female

Cisgender-Male

Gender Fluid

Genderqueer

Intersex

Transgender Female

Transgender Male

Prefer not to say

Prefer to self-describe

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* 8. Which race best describes you? (select the information that most describes you)

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

White / Caucasian

Native Hawaiian or other Pacific Islander

Other or Multi-Racial

Prefer not to say

Prefer to self-describe

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* 9. Ethnicity (select the information that most describes you)

I am not Spanish, Hispanic, or Latino

Hispanic or Latino or Spanish

Prefer not to say

Prefer to self-describe

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* 10. Veteran Status

I am a Veteran

I am related to a Veteran

I am active Military

I have not served in the Military

Prefer not to say

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* 11. To become certified, you do need to have at least a High School diploma. Please choose your highest education obtained.

General Equivalency Degree (GED)

High School Diploma

Associated Degree

Bachelor Degree

Graduate Degree

Doctoral Degree

I am actively enrolled in a GED program.

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* 12. Please share a short bio (5-7 sentences) outlining your lived experience and why you want to become Certified as a Recovery Peer Specialist?

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* 13. What does recovery mean to you? How long have you been in recovery? What were/are the important factors in your own recovery? What do you do for your own recovery management?

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* 14. What types of experiences have you had in assisting, or advocating for, people striving to reach recovery? (for example, mentoring, listening, facilitating groups, leading education program, sponsor, etc.)? Please be specific

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* 15. What are your views on mental health/substance use treatment (medication, traditional, and non-traditional)?

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* 16. Applicants must understand the key concepts of the program and attest to the following agreements. Please read and review and check each box: I attest to

Personal experience as a caregiver of a person or a person living in recovery from a mental health or substance use condition for a minimum of 2 years.

Please create a profile on https://namipinellas.volunteerhub.com/

Gather/ request 3 letters of recommendation

Begin to gather law enforcement and court records for any offenses that may require an exemption process to be initiated.

I understand that all NAMI programs are copyrighted. I will adhere to the Program Operating Policies and Code of Conduct, and will present according to these policies at all times.

to complete FCB’s three (3) hours of continuing education “Career Readiness for Peer Specialists” webinar as a pre-requisite.

Produce a copy of your state issued ID

Obtain a copy of your education certificate (GED or above)

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* 17. Please list any special needs (Dietary, accessibility, etc.):

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* 18. Statute requires all Certified Peers to pass a Level 2 Background Screening. If you have a blemish on your record, we can help you to move through the exemption process with DCF. However, a time frame must have passed and some charges, such as sex related charges, are not eligible for an exemption process. Please share below:

I have never been arrested

I was arrested but not convicted

I have a current level 2 background screen and am in the DCF clearing house.

I am hopeful to navigate the exemption process and become a certified peer.

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* 19. How did you find out about NAMI Peers in Recovery Program?

Family Member or Friend

Health Care Provider

NAMI-Pinellas.org/ NAMI Affiliate web site

Virtual NAMI Publication / e-mail/ constant content

My Employer is contracted to provide peer services

Other (please specify)

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* 20. Person to notify in Case of Emergency:

Name and Relationship to Applicant:

Email Address:

Phone Number:

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* 21. Please enter the email address you used to register your account on NAMI.org. This is a requirement before applying as it is how you will get access to your online training.

While this training is provided at no cost, a NAMI membership fee is required to access certain resources and benefits. Membership options include:

$5 Open Door Membership: For individuals who may not afford the full membership fee.
$40 Individual Membership
$60 Family Membership

Please follow these steps to set up your NAMI.org account and sign up for your membership:

1. Join NAMI: Sign up for Nami Account here: https://www.nami.org/About-NAMI/Join-NAMI

2. Sign Up Through Your NAMI Affiliate (Preferred): If you have a local NAMI affiliate, it is preferred that you sign up for your membership through them. This step ensures you're connected with local resources and community support. If you're unsure about your local affiliate, visit the NAMI website or contact us for guidance.

Should you encounter any difficulty in covering the membership fee, please do not hesitate to reach out to myself or Armour for assistance. It's important to us that everyone who wishes to participate can do so, regardless of financial situation.

NAMI.org Email address:

Hello!

Thank you for your interest in the Peers in Recovery Mentorship Program. Thank you for taking the time to invest in yourself and pursue a certification that allows you to share your story and experiences as a vessel to provide hope to others who are seeking the recovery path you have found. NAMI looks forward to walking this pathway together.

Please create a profile on https://namipinellas.volunteerhub.com/ and you can see opportunities to schedule an appointment with us to discuss your application. Once we are able to meet up in person or zoom, to ensure you are a good fit, we can update your profile in the volunteer HUB and invite you to the next orientation / overview so you can understand what is expected of you as a trainee and what to expect from us as trainers.

We also encourage you to review NAMI programs on the HUB and become familiar with the supports offered. Becoming a facilitator of these groups are one of the ways you can earn your required “On the Job” (OTJ) training hours towards your certification. You need to be a participant and a member of NAMI before you are allowed to lead them, so please begin accessing these valuable peer led supports.

When you click done, your application for the Peers in Recovery Mentorship Program (PIRMP) will be received. If you have further questions. Please connect directly with our NAMI Pinellas team. We will happy to assist you on your journey.

Jessica Kushner, Senior Program Manager
jkushner@nami-pinellas.org

Tracy Whyte, Peer Training Program Specialist
peersupport@nami-pinellas.org

C: 727-826-0807 | Help Line: 727-791-3434

www.nami-pinellas.org | FB: facebook.com/namipinellas | IG: @namipinellas | T: @namipinellas

Please click the "Done" button below to submit your application. Your application for registration is complete!