Transitional Age Youth

Transitional Age Youth

Intro to Peer Support Training
Participant Name
Gender
Address

Address

Street Address Line 2

CityState / Province

Zip
Phone
Email
example@example.com
Please select the training class you'd like to register for:
Please select all that apply:

I am the CONSUMER in recoveryI am the FAMILY MEMBER of the consumer in recovery
Please select all that apply to your selected identifier:

Drug MisuseMental IllnessTraumaCriminal History
Are you currently employed as a peer support professional in your community?

YESNO
How do you see yourself using your lived experience to support others in the recovery journey?
How will this training support your recovery and opportunities to contribute to your area's recovery community?
By signing below, I affirm that the information provided is true to the best of my ability and understand that any misinformation can be grounds for dismissal and revocation of consideration for the AKBH Intro to Peer Support training opportunity.
Participant Signature

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