Recovery Support Peer SpecialistTraining Application Please complete the entire appliction. Incomplete applications will not be considered. Approved State of Texas training for certifications Online | Virtual E-LearningApplicants must have a device with access to a video camera, stable internet, speakers or headset and mic to participate in the online training. Email * REGISTRATION Select Training Date * TBA SELECTION What do you hope to achieve by completing this training? * In the future I would like to pursue certification trainings for.... (select all that apply) * Peer Specialist Supervisor (PSS) Community Health Worker (CHW) Mental Health Peer Specialist (MHPS) Recovery Support Peer Specialist (RSPS) Peer Specialist Instructor Community Health Worker Instructor (CHW-I) ReEntry Peer Specialist (RPS) Do you require any accommodations? If so, please describe. (if not applicable, answer N/A) * Have you received a scholarship/voucher to cover the cost of training? * Yes (Continue to next section) No (Go to Previous Training) SCHOLARSHIP Which organization provided your scholarship? Peer Force TWC UT Health Via Hope OWRN PSS Diversity Expansion PREVIOUS TRAINING Have you ever registered/completed CORE MHPS, or RSPS training with One World Recovery Network? * Yes (Go to Recovery Experience) No (Go to Training Entity) TRAINING ENTITY Which training organization issued your training certificate? Not Sure Not Applicable Alliance Risk Group, LLC - Gateway to Sobriety APAA Center for Peer Learning & Development Center for Recovery and Wellness Resources Christopher Bailey Communities for Recovery Connection Center at San Antonio Clubhouse Cynthia Branch East Texas Council on Alcoholism and Drug Abuse Jack Lopez Jamie Bailey Jose Martinez Keep Enriching Youth Success - Keys to Houston Lifesteps Council on Alcohol and Drugs MHMR Tarrant Nexus Recovery Center Recovery Happens Regalado Recovery & Self-Discovery, Inc Regular People Consulting Rise Recovery San Antonio Council on Alcohol and Drug Awareness Santa Maria Hostel Strategic Recovery Solutions Texas Department of Criminal Justice The Center for Health Care Services The Montrose Center Triumphant Outreach Ministry/TOR Mental Health & Recovery Services Via Hope Violet McCain Willie Carter Community Outreach Center DEMOGRAPHICS Name First Name Last Name Phone Country (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Gender Male Female Prefer not to say Pronouns Not Sure No Pronouns - Use my name She/Her He/Him They/Them Ze/Hir Other Race/Ethnicity White/Caucasian Black/African American Asian Hispanic/Latino American Indian/Alaska Native Hawaiian Native/Pacific Islander Other Prefer not to say Birthdate (mm/dd/yyyy) Age 15-17 18 - 25 26 - 35 36 - 45 46 - 55 56 - 65 >65 Military Status Not Applicable Active Duty Veteran Disabled Veteran Education Did not complete school High School Diploma/GED Associate Degree Bachelor Degree Masters Degree Doctorates Degree EMPLOYMENT/VOLUNTEER EXPERIENCE Employment Status I am actively seeking employment as a Peer Specialist or similar Peer role I am currently employed as a Peer Specialist or similar Peer role I am currently volunteering in a Peer role I would like to explore volunteer/employment opportunities I am NOT interested in employment or volunteer opportunities If you are currently employed or volunteer in a Peer role/Peer Supervisor, please provide the agency information, i.e. agency name, phone number, supervisor name, supervisor phone number, email, etc. (if not applicable, answer N/A) Provide a brief description of current or previous Peer roles/responsibilities (if not applicable, answer N/A) RECOVERY EXPERIENCE How do you most often identify? * Not sure Ally - Not in recovery Educator - Not in recovery Peer Supervisor - Not in recovery Family/Friend of a person in or seeking recovery Substance Use - Personal lived experience in recovery Mental Health - Personal lived experience in recovery Substance Use & Mental Health - Personal lived experience in recovery How many years have you experienced sustained wellness? (if not applicable, answer N/A) * N/A Less than 2 years 2 - 3 years 4 - 5 years 6 - 10 years Greater than 10 years Not sure Recovery experiences are unique to each individual. Please share about your recovery journey, include ways in which you stay well and how you utilize your support network. (if not applicable, answer N/A) * CERTIFICATION STATUS Select all Peer certifications you currently have in Texas? (Check all that apply) * Not Applicable I am NOT certified in Texas Mental Health Peer Specialist (MHPS) Recovery Support Peer Specialist (RSPS) Peer Recovery Support Peer Specialist (PRSS) Peer Support Supervisor (PSS) ReEntry Peer Specialist (RPS) Family Partner TERMS AND CONDITIONS One World Recovery Network is an approved training entity in the state of Texas. We provide ALL state approved trainings for Peer Specialists and Peer Supervisors certifications; and Continuing Education (CEUs). Applicants acknowledge that the training is offered online only and they have a device with access to a video camera, stable internet, speakers or headset and mic to participate in the online training *Applicants must meet the technology requirements to participate in the training. Applicants agree to attend the entire training and actively participate including, but not limited to class discussions, group activities, roles plays, homework etc. Applicants agree to share their personal lived experience in recovery as it relates to mental health and/or substance use for the purpose of educating, role modeling and providing hope to others about the reality of recovery. Applicants acknowledge that after successfully completing the training they must take a knowledge assessment and pass with a score of 70% or greater. Applicants 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. Applicants understand that completing this training does not guarantee employment or a volunteer position with any agency/organization. Refund Policy No Refunds. Applicants may request a purchase credit through emailing One World Recovery Network at edu@oneworldrecovery.org or calling 855-275-7775. Applicants will receive a purchase credit that may be applied to any future training date within 180 days of original purchase. Purchase credits not applied within 180 days will be forfeited. One World Recovery Network reserves the right to decline registrations that do not meet eligibility requirements or constitute a risk. By selecting accept I am acknowledging that I have read and understand the terms and condition. * Accept One World Recovery Network is an approved training entity in the state of Texas. We provide ALL state approved trainings for Peer Specialists and Peer Supervisors certifications; and Continuing Education (CEUs). * Thank you!
