BeHOPE Application 2025 C4 09/23/2025

BeHOPE Application
If you are interested in becoming a registered Medi-Cal Peer Support Specialist please thoroughly complete all requested information in the application. INCOMPLETE APPLICATIONS MAY BE DELAYED OR REJECTED.

Payment must be completed at least 7 days prior to orientation date: September 23, 2025. Please review the training fee schedule here.
Payment Method

Self PayScholarship another organizationFee Waiver Scholarship (if available)
If you have a scholarship or your training is being paid for by another agency, what is the name of the agency paying for your training?
Personal Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
County of residence

Government Assistance Information
Are you a CalWORKs/TANF Participant?*

YesNoHave applied and are waitingDecline to answer
Are you currently receiving CalFRESH (i.e. food stamps) benefits?*

YesNo
Are you an SSI/SSDI (social security) recipient?*

YesNoNot Applicable

Demographic Information II
Are you currently struggling with Homelessness?*

YesNoNot homeless but close (in transitional housing, facing eviction)
Are you Justice-Involved? (Have you spent time in jail/correctional facility/prison?)*

YesNoDecline to answer
Do you struggle with low levels of English literacy? (Do you struggle to understand, read, write, or use English at a functional level)*

YesNo