Outside Training CEU Approval Form

Training Information

Please answer the below information regarding the training you are seeking CEU approval. If you received CEUs for a conference, please provide the below information for EACH training attended.
Training ONE
Training Title
Trainer Name

First NameLast Name
Training Provider Organization
Training Start Date

MonthDayYear
Date
Training End Date

MonthDayYear
Date
Type of Training

Other
Course/Training Duration (hours)
Number of CEUs/Contact Hours Requesting
Upload supporting documentation for Training One by clicking the "Browse Files" button (CERTIFICATE MUST INCLUDE TRAINING HOURS):

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Acknowledgement

I understand that Georgia Certified Peer Specialist-Parent (CPS-P) and Certified Peer Specialist-Youth (CPS-Y) work from the perspective of their lived experience with recovery from a mental health diagnosis and/or challenges. I agree to be open about the fact that I (as a CPS-Y have) or I (as a CPS-Parent who has a child that has) been diagnosed or live with a behavioral health challenge, and to use my lived experience to support other peers along their recovery journeys, as stated in the Certified Peer Specialist-Parent and Certified Peer Specialist-Youth Code of Ethics. I understand and acknowledge that as a CPS-P or CPS-Y, it is my responsibility to keep my certification active by maintaining the minimum CEU requirements that has been set before me and I agree to abide by and uphold the CPS-P and CPS-Y Code of Ethics. By printing and signing your full name below, you confirm that you have read the above acknowledgement statements and the information submitted on this application is true and accurate. You understand and acknowledge that GPSN may terminate your participation in the CPS-P or CPS-Y training, or move your certification status to inactive, if it is determined that false information was supplied on this form.
Print Your Full Name Here
Signature
Today's Date

MonthDayYear
Date
You will receive a confirmation response after you click the "Submit My CEUs" button that will indicate that your submission has been received. You will also receive a confirmation email from GPSN which will be sent to the "preferred email" that you entered in your application. As as a reminder, the email should be a personal email and not a work email. Thank you.
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Active CPS-P and CPS-Y CEU Submission Form

Please ONLY use this form to submit documentation of Continuing Education Units for CPS-Parent (CPS-P) and CPS-Youth (CPS-Y) if your certificate is up-to-date/ active.

Please Do Not Submit CEUs for 2025 or prior

Contact Information

CERTIFIED PEER SPECIALIST-PARENT/CERTIFIED PEER SPECIALIST-YOUTH EMPLOYMENT STATUS

Demographics

Certification Information

Training Information

Training ONE

Acknowledgement

Active CPS-P and CPS-Y CEU Submission Form

Please ONLY use this form to submit documentation of Continuing Education Units for CPS-Parent (CPS-P) and CPS-Youth (CPS-Y) if your certificate is up-to-date/ active.

****Please Do Not Submit CEUs for 2025 or prior****

Contact Information

CERTIFIED PEER SPECIALIST-PARENT/CERTIFIED PEER SPECIALIST-YOUTH EMPLOYMENT STATUS

Demographics

Certification Information

Training Information

Training ONE

Acknowledgement

Please Do Not Submit CEUs for 2025 or prior