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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
MM slash DD slash YYYY
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
PSS Training
MHPS Application
Core Training Application
Calendar
September 2025
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September 11, 2025
9:00 AM
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4:00 PM
September 15, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 16, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 17, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 18, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 22, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 23, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 24, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 25, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 29, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 30, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
Total
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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
MM slash DD slash YYYY
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
PSS Training
MHPS Application
Core Training Application
Calendar
September 2025
Sun
Mon
Tue
Wed
Thu
Fri
Sat
1
2
3
4
5
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9
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11
12
13
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30
September 11, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 15, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 16, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 17, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 18, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 22, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 23, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 24, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 25, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 29, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 30, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
Total
×
First Name
Last Name
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
Services
PSS Training
MHPS Application
Core Training Application
Calendar
September 2025
Sun
Mon
Tue
Wed
Thu
Fri
Sat
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
September 11, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 15, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 16, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 17, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 18, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 22, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 23, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 24, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 25, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 29, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
September 30, 2025
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
Total
×
First Name
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Last Name
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Email
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Phone
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Class they are interested in
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