Hope Holders' Alaska Navigators Registration Form
Please fill in this form to become registered in the HHAK Navigator in the Directory
Full Name
*
First Name
Last Name
Pronouns
Please Select
She/Her/Hers
He/Him/His
They/Them
Prefer no to say / Din not share
Organization (if affiliated)
Job Title:
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Please Select
Email
Phone
Text
Zoom
May we list your contact info in the public directory?
*
Please Select
Yes
No
Internal referral use only
Are you a Certified Peer Support Specialist (CPSS) in Alaska?
Please Select
Yes
No
If not Certified in the state of Alaska, would you like to become certified?
Please Select
Yes
No
Not at this time
Would like to Learn More
How long have you been a Certified Peer Support Specialist?
Please Select
Just Starting
6 months
1 year
2-3 years
4+ years
Areas of Lived Experience / Expertise
*
Substance Use Recovery
Mental Health
Co-occurring
Reentry / Justice Involved
Domestic Violence
Human Traficing
Grief and Loss
Suicide Prevention
Youth (18-24)
Elder Support
Veteran Support
Parenting / Family Peer
Kinship Care
Housing Instability
Tribal / Indigenous Communities
LGBTQ+ Support
Rural / Remote Communities
Other
Share Your Recovery Story:
Submit
Should be Empty: