California Association of Peer Supporters Academy Application

California Association of Peer Supporters Academy Application

Apply now to one of our training sessions starting this Summer (am/pm)
Applicant Requirements:

Applicants must have personal lived experience with a mental illness, addiction or justice-involvement and have experience as a consumer of services in the mental health system.

Applicants must also identify themselves as a person who has used, or uses, mental health services in their own recovery process. OR applicants must be an immediate family member of a person with a mental illness who has had experience as a consumer of services.

Applicants must plan to attend all sessions, which include classroom instruction via Zoom. Notification of any need to miss a class or leave early must be done verbally and in writing at least 24-hours in advance.

Applicants must secure their own transportation to internship sites in addition to the classroom in Huntington Park. (Currently all training and internships are online via Zoom).

Applicants must be able to communicate effectively using written and verbal skills.

Applicants must complete the application using a computer, independently and in their own words.

Applicants must have basic computer skills and the technical capability to participate.

Instructions:

All requested information must be provided and every question on this application must be completed. (Note: This DOES NOT include the “Voluntary Disclosure of Self-Identification” form on Page 8). Incomplete applications are defined as containing any blank information box or partially-answered essay question. If you need additional sheets, please put your name on each sheet and send them with your application.

Applications must be completed using a computer. You may type directly into the application and submit online once completed.

Each candidate must attend an interview before acceptance into the program. Dates/times for the interviews will be scheduled by the PRPSN Training Department.
Name: *

First Name Last Name
I liked to be called...
Preferred Name if different than name above
Pronouns: *
E-mail *

Confirmation Email example@example.com
Phone Number - Any phone number your provide PRPSN must be a consistently working number *

Area Code Phone Number
Alternate Phone Number

Area Code Phone Number
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How did you hear about the CAPS Academy? *
We appreciate you sharing this information with us!
If selecting 'referral' or 'other', please specify:
Have you applied to Project Return Peer Support Network training(s) in the past? (If yes, please state years and outcomes). If not, enter n/a
Class Schedule Preference Selection

Please select your preferred training times by selecting the priority for each schedule type.
1st Priority *

AM Mornings 9:00 am - 1:00 pm PM Evenings 6:00 pm - 10:00 pm
2nd Priority *

AM Mornings 9:00 am - 1:00 pm PM Evenings 6:00 pm - 10:00 pm
Alternative Contact Information

This is someone who could be reached in case of emergency or as a way to contact you if the information you provided above changes:
Alternative Contact Name *

First Name Last Name
Email
example@example.com
Phone Number *

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Applicant Written Essay

Please answer all of the questions below in your own words.
1) Please describe how your personal livedexperience of a mental health issue has made you the person you are today. *
2) Please describe your understanding/definition of a “peer professional.” What you think are the necessary skills peer professionals should possess? What do you expect to learn by the end of the training? *
3) What, if any, professional experience have you already had outside the mental health field? What is your long-term career goal, and how will participation in this training help you realize that goal? *
4) "Recovery” is a term often used in mental health care. Please define your personal definition of recovery, making sure to answer: What does recovery look like? Sound like? Feel like? *
5) Who is your personal inspiration? (This can include professionals, family, peers and/or friends). Describe, providing a specific example, how this person has influenced your life. *
6) What are the strengths that will assist you in fulfilling the obligations of this training course? What areas (time, distance, length of course, etc.) present challenges for you, and how do you plan to overcome those challenges if chosen to participate? *
7) What preparations do you have in place (financially, childcare, housing, self-care) to complete an eleven / twelve-week intensive training? *

Applicant Education & Career Accomplishments

Please provide as much information as possible related to your past and current education/training/employment/volunteer experience. Lack of previous education/training or paid employment will not disqualify you.

Education/Training – List all education/training, beginning with the most recent. If none, enter n/a in the first field *

	Name of Training/Agency	Degree/Certificate	Field of Study	Date(s) Completed
1.
2.
3.
4.
5.
6.

Paid/Unpaid Employment/Volunteer Experience – List all prior positions, starting with the most recent. If none, enter n/a in the first field *

	Agency Supervisor Name	Your Title	City & State	Dates	Paid or Unpaid
1.
2.
3,

Individualized Career Plan

Complete the individualized career plan (ICP) below to state your goal.
Example of Career Plan:

Name: Jane Ackerman

Example Career Goal: To successfully complete a peer certification training.

Example Requirements (What do I need to reach my goal):

I must have lived experience in recovery, apply to an approved peer certification training, participate in a selection process, I will need to have some computer skills to participate in the training and do homework, I must participate and ensure that I understand the material by asking questions and taking notes, I must pass the final exam to successfully complete the training and obtain my completion certificate.

Example Current Skills & interests:

I have lived experience in recovery. I am a mental health advocate. I have some computer skills and knowledge about using the internet, I am interested in learning more about how to be a peer supporting others.

Example Plan to Reach Goal (Who? What? How? Reasonable? Expected Result? Timed/When?:

I will successfully complete a peer certification training by applying to a peer certification training program, participating in a selection process by showing up to any interviews and being prepared to showcase my best self. If I take notes during class and study for the final exam, I am likely to pass the final exam and earn my completion certificate by October, 2022
Name: *
Career Goal: *
Requirements (What do I need to reach my goal?): *
Current Skills & interests: *
Plan to Reach Career Goal (Who? What? How? Reasonable? Expected Result? Timed/When?: *

Participant Agreement Form

Read each of the following statements thoroughly! Initial next to the statement you agree with.
I completed this application on my own Initial*
I used a computer to complete the application Initial*
I answered all questions in my own wordsInitial*

I intend to enter the mental health field either as a volunteer or paid employee upon completion of this course. Initial*

I intend to participate to my maximum ability during the eight-week training, including the classroom obligations. Repeated absences of more than 4 will result in elimination from the course. Initial*

I understand that Project Return Peer Support Network along with the California Association of Peer Supporters Academy is not a job placement program, and that PRPSN is under no obligation to find me a job or ensure my employment. Initial*

I understand that the content of the training is to provide me with core skills necessary for Peer Professional and/or entry level positions in the mental health field.Initial*

I agree to complete all required homework and classroom assignments.Initial*

I understand that in order to receive a certificate of completion, I must graduate from the class with everything completed. Initial*
Signature *

Clear
Type your Full Name here... *
Date *

Month Day Year
Date

Should be Empty:

California Association of Peer Supporters Academy Application

Class Schedule Preference Selection

Alternative Contact Information

Applicant Written Essay

Applicant Education & Career Accomplishments

Individualized Career Plan

Participant Agreement Form

Thank you!