Participant First Name

Participant Last Name

Participant Address

Participant Email

Enter Email Confirm Email
This is the address where we’ll send your training log-in details. Please make sure you can access the email address you provide on the day of your training.

Participant Phone

Are you currently working for an agency that has certified peer specialist that you will be supervising after this training?

Yes

No

Employment Status

Full-time

Part-time

N/A

What is your concept of recovery and what does it mean to you?

What is your concept of the role of a PSS and why do you want to be one?

What things do you do to maintain your wellness?

Participation Requirements Checklist

I will attend and actively participate in the full two days of training.

I will confirm with both TCI and the trainers, in advance, if I need to be absent.

I understand that two (2) hours is the maximum I can be absent for legitimate emergency situations.

I understand that if I do not confirm my absence with the trainers and TCI in advance I may not be eligible to complete the training and sit for the certification exam.

I will participate in discussion and role-plays utilizing my personal experiences and sharing my mental health recovery story.

I understand that I am not guaranteed employment or a volunteer position as a result of participating in this training.

Are there reasonable accommodations for disability needed?

Yes

No

Date

Gender

Male

Female

Age Group

18-25

26-35

36-55

55+

Race/Ethnicity

Are you either an Active Member or Veteran in the Armed Forces?

Yes

No

Services

Calendar

April 2026

April 30, 2026

2:00 PM

3:00 PM

4:00 PM

Total

First Name

Last Name

Address:

(Please provide complete mailing address as this will be where any physical materials would be mailed to.)

Preferred Email

All communication regarding this training will be sent to this email address.

Preferred Phone

Candidate Eligibility Checklist

I have read the application supplement.

I am 18 years or older.

I have a High School Diploma or GED. (If you apply for certification following the training, you will be required to provide documentation of a minimum education level of a high school diploma, GED or highest level obtained.)

I myself completed this application.

I identify myself as a person who has personal lived experience with mental health recovery.

I have significant experience working on my recovery and I am able to manage my own wellness.

I agree to disclose my personal lived experience as it relates to mental health for the purpose of educating, role modeling and providing hope to others about the reality of recovery.

I have lived experience with mental health recovery or a co-occurring disorder, rather than a substance use diagnosis only.

Recovery Experience

Do you currently hold a peer support position (paid or volunteer) and expect to do the work of a Mental Health Peer Specialist following this training?

Yes

No

Employment Status

Full-time

Part-time

N/A

What is your concept of recovery and what does it mean to you?

What is your concept of the role of a MHPS and why do you want to be one?

What things do you do to maintain your wellness?

Participation Requirements Checklist

I will attend and actively participate in the full five days of training.

I will confirm with both TCI and the trainers, in advance, if I need to be absent.

I understand that four (4) hours is the maximum I can be absent for legitimate emergency situations.

I understand that if I do not confirm my absence with the trainers and TCIin advance I may not be eligible to complete the training and sit for the certification exam.

I will participate in discussion and role-plays utilizing my personal experiences and sharing my mental health recovery story.

I acknowledge that TCI may take photographs during the training for inclusion in any and all of its publications, including social media. If I do not wish to be included, I will notify TCI before the start of training.

I understand that I am not guaranteed employment or a volunteer position as a result of participating in this training.

I agree to take the exams following the Core and Specialized training.

Are there reasonable accommodations for a disability needed?

Yes

No

Date

Gender

Male

Female

Age Group

18-25

26-35

36-55

55+

Race/Ethnicity

Are you either an Active Member or Veteran in the Armed Forces?

Yes

No

Services

Calendar

April 2026

April 30, 2026

2:00 PM

3:00 PM

4:00 PM

Total

First Name

Last Name

Participant First Name

Participant Last Name

Participant Address

Participant Email

This is the address where we’ll send your training log-in details. Please make sure you can access the email address you provide on the day of your training.

Participant Phone

Services

Calendar

April 2026

April 30, 2026

2:00 PM

3:00 PM

4:00 PM

Total

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April 30, 2026

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April 2026

April 30, 2026

April 2026

April 30, 2026

Core Training

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April 2026

April 30, 2026

April 2026

April 30, 2026

April 2026

April 30, 2026