Date
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MM
DD
YYYY
Select Training Date
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MHPS: January 6-10 - $500
I'm interested in becoming certified as...
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Do you have a scholarship?
No
Yes
If yes, please indicate from which agency.
No Scholarship
ViaHope
UTHealth
PeerForce
Name
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First Name
Last Name
Email
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Phone Number
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(###)
###
####
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
What is your gender identify?
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Select the term(s) with which you most identify, even if the same as above.
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Agender
Gender Non-conforming
Intersex
Transgender Man
Cisgender (non-trans) Man
Gender Variant
Non-binary
Transgender Woman
Cisgender (non-trans) Woman
Genderqueer
Not listed
Race/Ethnicity
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What are 3 things you do to maintain your wellness in recovery?
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Do you currently work in a paid or volunteer peer role?
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No
Yes
If yes, please provide Supervisor Name, Title and Phone Number.
Please describe any prior experience in peer support not mentioned above.
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Are you currently seeking employment in the role of Peer Specialist?
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No
Yes
Age
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15-17
18-25
26-35
36-45
46-55
55+
Education
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Did not complete school
High School Diploma / GED
Associate Degree
Bachelor Degree
Masters Degree
Doctorate Degree
I identify myself as a person who has personal lived experience with substance use or co-occurring recovery
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No
Yes
Unsure
I am comfortable sharing my recovery story with others.
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How many years/months do you have in recovery?
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Enter the number of years and months that you have sustained recovery.
I have significant experience working on my recovery, and I can manage my wellness. *
Yes
No
Unsure
Share a description of your substance use or co-occurring experience and the tools/practices you use to maintain your recovery.
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Terms and Conditions
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APAA is a certified training entity. We provide state-approved training for Peer Specialist in the state of Texas only.
During training, cell phone usage and other distractions are not allowed to ensure a productive learning environment. No more than 15 minutes of classroom time can be missed on any given day.
Participants agree to provide true and correct information in their application. Participants acknowledge that training may be offered online and if so, they will be expected to have access to a computer, stable internet, mic/speakers or headset. Participants that do not meet all of these requirements will not be allowed to participate in the training.
Participants agree to attend the entire training and actively participate in activities including, but not limited to, class participation, break out sessions, role playing, homework etc.
Participants agree to share their personal lived experience in recovery as it relates to substance use or mental health for the purpose of educating, role modeling and providing hope to others about the reality of recovery.
Participants acknowledge that after successfully completing the training they must take a knowledge assessment and pass with a score of 70% or greater. Participants that do not pass the knowledge assessment will be allowed to retake the assessment a total of 2 times. After the second attempt, if the participant does not pass the knowledge assessment they will be required to retake the training.
Participants understand that completing this training does not guarantee employment or a volunteer position with APAA.
No Refunds. Purchaser will receive a credit that may be applied to another training date within 60 days of original purchase. If credit is not used within 60 days purchaser will be required to make a new purchase.
We reserve the right to determine the eligibility of participants approved to attend training.
By selecting accept, you are acknowledging that you have read/understand the terms and conditions.
Type name in lieu of a signature.
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How did you hear about us?
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How did you learn about APAA trainings?
