Ready 4 Reentry Forensic Peer Mentor Training Cohort 20

Georgia's Forensic Peer Mentoring Project, established in 2015, provides support, linkage, and care coordination to promote the successful community reintegration of adults with behavioral health diagnoses returning to the community following incarceration.

Forensic Peer Mentors have had personal lived experience with the criminal justice system. The Forensic Peer Mentor works with returning citizens/participants who are within 3-18 months of their release date/tentative parole month. They work together onsite within an assigned state correctional facility, or in a Georgia Day Reporting Center, as well as in the community after release. The Forensic Peer Mentor provides support, including linkage and assistance in developing transportation plans to community services to facilitate access to entitlements, community based behavioral health supports and other services.

The Ready 4 Reentry Forensic Peer Mentor Training Program provides Certified Peer Specialists the tools, skills, and resources to support Georgia's returning citizens. Learn more about Forensic Peer Mentoring at our website.

Full Legal Name*

First NameLast Name

Preferred Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

Race*

Sex*

FemaleMaleTransgenderOther_____________________

County

Primary Phone Number*

Area CodePhone Number

Work Phone Number

Area CodePhone Number

E-mail*

DEMOGRAPHICS

PLEASE CHECK THE REGION WHERE YOU RESIDE*

Region 1 (Dade, Walker, Catoosa, Chattooga, Whitfield, Murray, Gordon, Floyd, Bartow, Polk, Paulding, Haralson, Cobb, Douglas, Fannin, Gilmer, Pickens, Cherokee, Union, Lumpkin, Dawson, Forsyth, Towns, White, Hall, Rabun, Habersham, Banks, Stephens, Franklin, Hart)Region 2 ( Jackson, Madison, Elbert, Barrow, Walton, Morgan, Oconee, Clarke, Oglethorpe, Greene, Wilkes, Taliaferro, Warren, McDuffie, Lincoln, Columbia, Richmond, Glascock, Jefferson, Emanual, Burke, Jenkins, Screven, Jasper, Putnam, Hancock, Baldwin, Washington, Wilkinson, Jones, Monroe, Bibb, Twiggs)Region 3 ( Clayton, Dekalb, Fulton, Gwinnett, Newton, Rockdale)Region 4 (Terrell, Calhoun, Early, Miller, Lee, Dougherty, Baker, Worth, Seminole, Decatur, Mitchell, Grady, Thomas, Colquitt, Turner, Tift, Cook, Brooks, Ben Hill, Irwin, Berrien, Lanier, Lowndes, Echols)Region 5 ( Bleckley, Pulaski, Wilcox, Dodge, Laurens, Telfair, Wheeler, Montgomery, Treutlen, Johnson, Coffee, Atkinson, Clinch, Bacon, Ware, Pierce, Charlton, Brantley, Toombs, Appling, Wayne, Candler, Tattnall, Evans, Bulloch, Long, Liberty, Bryan, Effingham, Chatham, McIntosh, Glynn, Camden)Region 6 (Carroll, Heard, Troup, Coweta, Meriweather, Harris, Muscogee, Chattahoochee, Stewart, Quitman, Clay, Randolph, Talbot, Fayette, Spalding, Pike, Upson, Lamar, Henry, Butts, Crawford, Peach, Houston, Taylor, Marion, Webster, Schley, Sumter, Macon, Dooly, Crisp)

Are you currently working in a role as a Forensic Peer Mentor?*

YesNo

Current employer or volunteer work:*

Current Job Title:*

Briefly describe the people you currently serve (i.e., Adults, Youth/Young Adults, Veterans, Court-Involved Persons, Returning Citizens, etc.): *

PLEASE CHECK THE REGION WHERE YOU WORK*

Region 1 (Dade, Walker, Catoosa, Chattooga, Whitfield, Murray, Gordon, Floyd, Bartow, Polk, Paulding, Haralson, Cobb, Douglas, Fannin, Gilmer, Pickens, Cherokee, Union, Lumpkin, Dawson, Forsyth, Towns, White, Hall, Rabun, Habersham, Banks, Stephens, Franklin, Hart)Region 2 ( Jackson, Madison, Elbert, Barrow, Walton, Morgan, Oconee, Clarke, Oglethorpe, Greene, Wilkes, Taliaferro, Warren, McDuffie, Lincoln, Columbia, Richmond, Glascock, Jefferson, Emanual, Burke, Jenkins, Screven, Jasper, Putnam, Hancock, Baldwin, Washington, Wilkinson, Jones, Monroe, Bibb, Twiggs)Region 3 ( Clayton, Dekalb, Fulton, Gwinnett, Newton, Rockdale)Region 4 (Terrell, Calhoun, Early, Miller, Lee, Dougherty, Baker, Worth, Seminole, Decatur, Mitchell, Grady, Thomas, Colquitt, Turner, Tift, Cook, Brooks, Ben Hill, Irwin, Berrien, Lanier, Lowndes, Echols)Region 5 ( Bleckley, Pulaski, Wilcox, Dodge, Laurens, Telfair, Wheeler, Montgomery, Treutlen, Johnson, Coffee, Atkinson, Clinch, Bacon, Ware, Pierce, Charlton, Brantley, Toombs, Appling, Wayne, Candler, Tattnall, Evans, Bulloch, Long, Liberty, Bryan, Effingham, Chatham, McIntosh, Glynn, Camden)Region 6 (Carroll, Heard, Troup, Coweta, Meriweather, Harris, Muscogee, Chattahoochee, Stewart, Quitman, Clay, Randolph, Talbot, Fayette, Spalding, Pike, Upson, Lamar, Henry, Butts, Crawford, Peach, Houston, Taylor, Marion, Webster, Schley, Sumter, Macon, Dooly, Crisp)

REQUIRED PREREQUISITE QUESTIONS
For each of the four questions below that you provide a "Yes" answer to, you will be required to submit a certification document. Instructions for submitting documentation are at the bottom of this page.

1. Are you currently a Certified Peer Specialist-Mental Health?*

YesNo

2. Are you currently a Certified Peer Specialist-Addictive Disease?*

YesNo

3. Are you currently a Certified Peer Specialist-Parent?*

YesNo

4. Are you currently a Certified Peer Specialist-Youth?*

YesNo

4. Are you a justice impacted individual? (Meaning you are an individual that has been affected by the criminal justice system, either through being incarcerated, being on probation, parole, etc)*

YesNo

INTEREST AND INVOLVEMENT
Please briefly answer each of the following questions.

5. What is peer support?*

0/500

6. Why are you applying for this training?*

0/500

7. How would you describe your experience as a returning citizen?*

0/500

8. Describe your experience assisting or advocating for individuals involved in the criminal justice system or other people living with behavioral health challenges.*

0/500

9. Please check the box that describes your current involvement in the criminal justice system:*

I am on probationI am on paroleI am not on supervision

10. Please provide your last sentence end date:*

Date

11. Please check all that apply:*

I have received a pardonI have received record restrictionI have not received a pardon or record restriction

Do you have any pending charges or recent arrests?*

YesNo

12. Please explain any pending charges or recent arrests.

0/500

13. Do you have fluency in languages other than English and do you know ASL (American Sign Language? If so, please specify.*

0/500

14. Which of the following will you have access to during the training?*

InternetLaptop/Desktop

Please attach a copy of your CPS certification. *

Browse Files

All documents must be received electronically or date-stamped by the deadline date for this application to be considered complete.

Signature*

Specific information about training times and login information will be sent upon notification of acceptance for training.

This training was developed by the Georgia Mental Health Consumer Network. Funding for this training was provided by the Substance Abuse and Mental Health Services Administration through a Center for Mental Health Services Statewide Consumer Network Program grant and the Georgia Department of Behavioral Health and Developmental Disabilities.

Cohort 20 Online Training: Wednesday, April 23rd through Friday, April 25th, 2025