Clone of CPS-Y Training Application Form

Please complete this application in its entirety and be sure to answer all questions. We ask that you fill out all information to the best of your knowledge. Before submitting your application, be sure to fill out all required sections and attach all required documentation.

Georgia Parent Support Network and the Georgia Department of Behavioral Health and Developmental Disabilities and consumer leadership have worked collaboratively over the past 20 years to build a lived experience workforce supporting Recovery for individuals living with a mental health condition and/or with a substance use disorder.

This lived experience workforce of Certified Peer Specialists for mental health and addiction has not only changed thousands of lives, but it has also impacted the culture of the behavioral health system, infusing respect, recovery, wellness and empowerment throughout the system.

GPSN and DBHDD is now invested in expanding this highly valued workforce to include youth living with Mental Health Conditions, Substance Use Disorder (SUD) or Co-Occurring Behavioral Health (BH) disorders. The goal is to impact youth serving systems with support to other youth and their wellness.

Certified Peer Specialist-Youth (CPS-Y) - Is an individual who is a young adult, ages 18 through age 26, with lived experience living with a mental health or substance use condition, or both and who has received behavioral health services as a youth and is willing and able to self-identify as a person living with a behavioral health condition and is prepared to use that experience in helping other youth and young adults living with similar behavioral health conditions.

Georgia Parent Support Network is now accepting applications from young adult, 18-26 or who meet the lived experience expectations, meet the following criteria and who desire to work in the capacity of a Certified Peer Specialist-Youth and who intend to provide 20-40 hours per week of direct youth/young adult peer support:

Candidates must be a young adult between 18 & 26 living with a mental illness, substance use, and/or co-occurring diagnosis (a mental health condition must be the primary diagnosis) along with the following:

1. Be able/willing to actively seek and manage your own appropriate care.
2. Be able to share their own personal story in a safe and appropriate way.
3. Must be well grounded in recovery wellness.
4. One year between diagnosis and application to training.
5.If the individual has a substance use condition, there must be one year continuous abstinence from substance use.
6. Have access to a laptop or desktop computer (cell phones or tablets will not be accepted). You will not be able to take the test at the end of each day on a phone or tablet.

It is a requirement for cameras to be on at all times during the training with no exceptions.

Priority will be given to those who are currently providing youth peer support services and those who currently work in that role.

Please select which training dates you are applying for:*

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

Date of Birth*

Date

Personal e-mail*

example@example.com

Phone Number*

Please enter a valid phone number.

Race*

Gender Identity*

MaleFemaleLGBTQIA2S+Other

Referring Agency/Organization*

Are You currently working with a behavioral health provider providing peer support as a CPS-Y?*

If you answered yes, please answer the following:

Agency Name

Job Title

Work e-mail

example@example.com

Do you plan to apply for a job with a behavioral health provider providing peer support as a CPS-Y?*

Emergency Contact

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone*

Please enter a valid phone number.

Please follow these instructions for the next few pages.

A. Please answer the questions below, regarding your lived experiences.

1. Why do you want to become a Certified Peer Specialist -Youth (CPS-Y)? *

2. Tell us about your diagnosis and what it means to you (mental health, addiction, or co-occurring), how it impacted your life and what things you did to change that. Talk about how long you have been taking care of your own recovery/wellness.*

3. Give an example of when you advocated for your own mental health or substance use services.*

4. Give an example of when you used your lived experience story to address stigma. *

B. If you are a young adult who does not intend to provide the service of Youth Peer Support, please explain below:

1. Please provide details regarding how you intend to use the information gained from this training in your professional practice.*

GUIDELINES AND RULES

Here are guidelines and rules for the training, please initial beside each one to show you have read and understand them.*

C.

Provide Photo (ID) (attach ID in the box below). ID background must be on a plain surface and clear to read. Please crop to the edge of the ID on all sides.

Provide (2) letters of reference (attach them in the boxes below). Note: This cannot be from a family member or friend. Must be form an employer or professional service provider.

Reference letters should speak to the following:

* The Applicant demonstrates leadership qualities as it relates to recovery

* The Applicant is working on a quality recovery plan

* The Applicant conveys hope to others requarding recovery and wellness

* The Applicant demostrates reliability and accountability in their own recovery

* Person providing letter please include your contact information

CPS-Y Training Application 2026