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  • Peer Support Specialist Screener

  • Date of Birth*
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  • Have you received peer support services?*
  • Have you received mental health services?*
  • Do you consider yourself to be actively in recovery from a mental health condition, diagnosis or major life disruption?*
  • Do you self-identify and disclose your mental health recovery journey publicly to peers and others?*
  • Have you provided peer support services by: (Check all that apply)*
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  • Please include the name and contact information for 3 references from individuals able to speak to your abilities as a peer specialist, using your recovery skills to support others. Letters should contain specific details and descriptions of your strengths, skills and abilities that will make you an effective peer specialist.

    Please do not list your current supervisor, relatives, close friends, or current providers as references. Some ideas for who can be a reference: colleagues at your current job; former supervisors or co-workers; leaders or support people in your community who know your work in a volunteer capacity.

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