September 2023 CPS Application

Massachusetts Certified Peer Specialist Application ONLINE

We are delighted that you are interested in this unique training! The CPS team at The Kiva Centers is honored to interview each candidate. We select students who have experience in mental health peer support to participate in the training and certification exam, preparing CPS's to work in a variety of settings.

Your ability to follow directions on how to apply is part of the selection process on whom is accepted into the training.

We consider all 3 parts of your application packet:

1) this online application,

2) two references filled out through the link

3) your interview

*Please note references have changed*

Two (2) references are required.
There is a new method of obtaining Certified Peer Specialist references. Please forward your referees the email with the reference link, that you will receive upon completing this application. The reference form will ask a few brief questions about you as a candidate and will be submitted directly to us.

One reference must be from someone directly involved in peer support.

Family members may not provide a reference. References from treatment providers detailing your “mental health diagnosis” and treatment are discouraged.

Please do the following:

1) Complete this application

2) Schedule an interview (link will be sent to you once we receive your application)

3) Send the reference link to your two references for them to complete (Link at bottom of application and sent via email after you submit your application)
I have read all the information above*

Yes
I am 18 years or older*
My primary lived experience with recovery is related to my mental health and ortrauma, even if I have my own lived experience with addiction recovery.*
I live or work in Massachusetts*
I have a high school diploma or equivalent*
You have entered no on one of the requirements. For more information please email cps@kivacenters.org
Name*

First NameLast Name
Name you would like to be called (if different than above)

First NameLast Name
Address:*
Town/City:*
State:*
ZIP:*
Email:*
example@example.com
Cell phone &/or other*
2. Are you a Veteran?*

NoYes (if so please complete box below)
Do you work or volunteer in a peer role for a Veteran's Association*

workvolunteerNot Applicable
3. Have you applied to the Massachusetts CPS Training before?*

yesno
If yes, when did you apply for the Massachusetts CPS Training?*
Have you been in the CPS Training before?*

yesno
If yes, when were you in the Massachusetts CPS Training?*
How did you find out about the Massachusetts CPS Training?*
5. Current work*

Employed in a Peer Specialist PositionEmployed in a Recovery Coach PositionVolunteering in a Peer Support RoleEmployed in a human service position that does NOT expect you to disclose your lived experienceEmployed in a non-mental health fieldUnemployed and not volunteering
6. Role or job title *
7. Organization/Agency that you work for If working in more than one, check the organization that is supporting you to attend CPS training OR where you work the most hours. If not employed or volunteering skip to "Voluntary Demographics" and complete pages #2, #3, #4.
8. Supervisor and Program Our funder asks for the names of students' supervisors. However we will NOT share any information about you to your supervisor as the classroom is a confidential learning environment.
Name of Supervisor:
Supervisor Email
example@example.com
Supervisor Phone Number

Area CodePhone Number
Program:
Work address:
Town/City:
9. Does your position require CPS certification based on the new ACCS model (Adult Community Clinical Services) which began July, 1st 2018?*

yesnodo not know
Has your employer required you to be certified by a certain date? If yes, what is that date?*

YesNo
Date certification is required by if applicable:*
11. What are your job duties? Please check all that apply.

Peer Support Warmline (Telephone Support)Facilitate support groups (general, HVN, WRAP, WHAM, etc.)Support people with getting disability, housing or other benefitsSupport people with education or employment goalsShare your recovery story publicly (In Your Own Voice, etc.)Part of a PACT TeamPart of an ACCS TeamPart of an ESP or BEST TeamPart of an RLCPart of DMHPart of VAPeer Mentor – Young AdultLiving Room/peer-to-peer supportHelp people develop their goals for recovery or treatmentWrite progress or treatment notesProvide training to other staff on recovery issuesOther Type of Program or Duties
12. Hours/week you work

1-5 hours\week6-11 hours\week12-19 hours\week20-32 hours\week32-39 hours\week40 hours and over
Length of time in your current position

0-5 months6-11 months12-18 months19-24 months2-4 years5 years or more
The following questios are voluntary. Your acceptance will not be influenced by whether or not you complete some or all of this section. This informations is used to look at the overall diversity of each CPS class and compare it to the overall diversity of applicants to the CPS Trainings.
14. (Optional) Age

18-2020-2930-3940-4950-5960 and over
15. (Optional) Race/Ethnicity

African AmericanBlackAsianHispanic/LatinoCaucasian - Not HispanicIndigenous/Native American/AlaskanMiddle EasternMultiracialOther (specify below)
Other & Comments
16. (Optional) Gender

FemaleMaleTransgenderNon-binaryAgenderOther
17. (Optional) Sexual Orientation

LGBTQIA+HeterosexualOther orientation
Other/Comments
18. (Optional) Pronouns

She/her/hersHe/him/hisThey/them/theirsOther pronouns
Pronouns
19. (Optional) Highest Level of Education

High School or equivalentSome collegeCollege degreePostgraduate degreeOther education
Other/Comments
*20. Why do you want to become a Certified Peer Specialist?*
21. How do you plan to use this training?*
*22. What peer-led activities have you participated in? Check all that apply*

Recovery Learning Community (RLC)Peer Recovery Support Center (for substance use support)Vet-2-VetDBSA (Depression & Bipolar Support Alliance)NAMI (National Alliance on Mental Illness) ConnectionsLatinos en AcciónBUR (Blacks United in Recovery)Hearing VoicesRecovery Out LoudOne-to-one peer supportAA/NAOther 12-stepOther peer-led activitiesPeer to Peer Support GroupsAlternatives to SuicideNone
Other*
23. How have you used what you learned from the above activities in your life or work?*
24. What formal peer trainings have you completed, if any?*

Wellness Recovery Action Plan(WRAP)WRAP Advanced Level FacilitatorAlternatives to SuicideAddictions & Trauma Integration ModelWhole Health Action Management (WHAM)Gathering Inspiring Future Talent (GIFT)Recovery Coach AcademyRecovery MessagingCertified Older Adult Peer SupportForensic Peer SupportTrauma Informed Peer Support (TIPS)Peer Facilitator Training8 Dimesions Of WellnesSTAIROtherNone
Other Please list below
25. How have you used what you have learned from the above trainings in your life or work?*
*26. When it comes to mental health, what does your own recovery mean to you?*
*27. Peer support is at the core of our role as peer support specialists. Please provide at least 1 specific example of how you have received and/or given mental health peer support.*
28. The training team will prepare you to tell your 5 minute mental health recovery story, this is part of the class requirements. Do you agree to share your story with the class?*

yesno
29. Please share at least 3 examples of why it is important for peer specialists to share their recovery story.*
30. What skills, supports, or resources have you used in your recovery?*
31. What supports or resources have played an important role in supporting you to move forward? We are especially interested in supports you have developed in the community, outside of your treatment team.*
32. Share something you would like to change for the better in your work place, volunteer site or where you receive services, include how you would help facilitate this change.*
33. If you are not employed in a peer support position, what are your plans for seeking employment in the field? Check as many as apply and add any other plans.*

Searching onlineNetworking with people I know in the fieldNegotiating with specific agency(s)Have applied alreadyHave interviewed alreadyOther plans
33. If you are not employed in a peer support position, what are your plans for seeking employment in the field? Check as many as apply and add any other plans.*

Searching onlineNetworking with people I know in the fieldNegotiating with specific agency(s)Have interviewed alreadyNone
34. I completed this application on my own.*

yesno
35. I identify as having my own lived experience with a mental health condition, emotional distress and or trauma resulting in significant life disruption.*

yesno
36. I have been out of inpatient and or day treatment for over a year.*

yesno
If no, please tell us more about your readiness to take the CPS course at this time.
37. I understand that the CPS training is not a job placement program.*

yesno
38. If accepted, I agree to take the certification exam following completion of the training.*

yesno
39. I intend to maintain or seek employment as a CPS.*

yesno
40. I have a high school diploma or equivalent. (If requested, I can provide documentation)*

yesno
41. The CPS course requires homework and study time between classes. I am prepared to invest the time needed.*

yesno
42. This class will be online. Do you have access to a laptop and highspeed internet connection?*

yesno
43. The class is live online. Do you have a designated place that will be free from distractions and where there will be no other people?*

yesno
44. If accepted, I understand and consent with the CPS policy that my name and other information will be shared with the CPS program funders*

YesNoOther
45. Is there anything else you feel we should know about your preparation to become a Certified Peer Specialist?
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