• BeHOPE Application

    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.

    Important: Applicants requesting a training fee waiver must begin coursework within 72 hours of program acceptance.
    Failure to begin module completion within this timeframe may result in forfeiture of the fee‑waiver seat and reassignment to another eligible applicant.

    For self-pay applicants payment must be completed prior to orientation. If you are applying under the fee waiver program.  Please review  the training fee schedule here.

  • Payment Method

  • Personal Information 

  • Format: (000) 000-0000.

  • Education, Employment and Household Income

  • Current School Status (please read carefully)*
  • Are you currently employed with a community-based organization (a public-service nonprofit agency)?
  • Are you currently employed in a peer support role? (Behavioral health, education, child welfare, corrections, rehabilitation, etc.)
  • Are you currently employed with a county behavioral health agency?
  • Are you a Dislocated Worker? (Laid-off or received advance notice of termination)*

  • Demographic Information I

  • Race/Ethnicity (You can choose more than one if applicable)*
  • Gender*
  • What is your age category?*
  • Is English a second language for you?*
  • Active military/veteran?*
  • Do you identify as having a disability?*

  • Demographics Information (cont'd)

  • Are you an immigrant?*

  • Government Assistance Information

  • Are you a CalWORKs/TANF Participant?*
  • Are you currently receiving CalFRESH (i.e. food stamps) benefits?*
  • Are you an SSI/SSDI (social security) recipient?*

  • Demographic Information II

  • Are you currently struggling with Homelessness?*
  • Are you Justice-Involved? (Have you spent time in jail/correctional facility/prison?)*
  • Do you struggle with low levels of English literacy? (Do you struggle to understand, read, write, or use English at a functional level)*
  • Do you need any special accomodations to complete this training?

  • Thank you for completing the application and for your interest in the BeHOPE Medi-Cal Peer Specialist Training program. 

    Once your application is received it will be reviewed and you should receive a response within 48 hours or on the first business day following submission. 

    You will be provided with a link for registration and emailed updates in the weeks leading up to orientation. 

    We look forward to serving you!!

  • Should be Empty: