I am 18 years of age or older **Yes No
I have a high school diploma or GED yes no*
I am a person with lived experience with my OWN substance misuse/Mental Health Challenges: Yes No*
I have accessibility needs (such as hearing, visual, executive or other considerations) * yes No
Education * High School Diploma GED Technical Degree Bachelor's Degree Master's Degree Doctorate's Degree Associates Degree Some College
Do you currently hold a paid or volunteer position as a peer? * yes no*
Please indicate your race White Hispanic/Latino Black/African American Asian Native Hawaiian or other Pacific Islander Other
Age 18-25 26-35 36-45 46-55 55+
Are you active duty U.S. military or veteran? yes no
I have read and understood all of the items in this application and attest that I, myself, filled it out I agree*
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