MA PWC Member Information Form

A coalition of Recovery Coaches, Certified Peer Specialists, Community Health Workers, Family Partners, YA Peer Mentors, Certified Older Adult Peer Specialists, and other lived experience professionals
The Massachusetts Peer Workforce Coalition is a collective of peer professional leaders representing Recovery Coaches (RCs), Certified Peer Specialists (CPSs), Community Health Workers (CHWs), Family Partners (FPs), Young Adult Peer Mentors (YAPMs), and Certified Older Adult Peer Specialists (COAPSs). Over the past few years, we have met consistently in a collaborative effort regarding training, expanding diversity, equity, and accessibility within our programs, and sharing best practices. Our goal is to bring the collective voices of people with lived experience so that they can shape any and all policies that impact our work.
Member Information
Name*

First NameLast Name
Pronouns:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Organization/ role:
What certified peer support training have you completed, if any?
Do you have lived experience?

YesNoOther
Do you work in a lived experience and or peer support profession?

YesNoOther
Are you in a direct service role or oversee a contract for a direct service program?

YesNoOther
Should be Empty:

A coalition of Recovery Coaches, Certified Peer Specialists, Community Health Workers, Family Partners, YA Peer Mentors, Certified Older Adult Peer Specialists, and other lived experience professionals