Peer Wellness Specialist Application

The role of the Peer Wellness Specialist is to provide peer support, encouragement, and assistance to address physical and mental health needs. In order to do that, it is important that the Peer Wellness Specialist has a working knowledge of the various health care and wellness resources in their community and how to access these services and resources.

Application Guidelines: Complete applications will be reviewed on a first-come, first-serve basis. Applicants who have not secured funding for the training will not be considered complete. Once you complete this application, you will receive confirmation that it has been submitted.

Applications submitted within 7 days of the class start date are not guaranteed a spot. Training details and materials will be shared approximately 2 - 4 weeks prior to the training start date for the cohort for which you have applied.

Cancelation and Refund Policy: If registering two or fewer weeks prior to the training start date, you acknowledge that no refunds will be provided. If you submit a cancellation request two business days or more prior to the training start date, then you will be eligible to use your full training credit towards a future PWS training within a one-year period. No cash refund will be provided.

For general information or other questions, please reach out to pws@thepeercompany.org.

Virtual Training Dates

January 5th-January 22nd (9am to 3:30pm)February 9th-February 26th (9am to 3:30pm)March 9th-March 25th (9am to 3:30pm)

In-Person Training Dates

January 5th-January 16th (9am to 5pm)February 9th-February 23rd (9am to 5pm)March 9th-March 20th (9am to 5pm)

Name*

FirstLast

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

Age Range*

Do you currently live in a rural community (population of 50,000 or less)?*

YesNo

What is your preferred language? (please note that this question is for statistical purposes only. Unfortunately, we do not have the ability to provide interpreter services.)*

How do you identify your race, ethnicity, tribal affiliation, country of origin, or ancestry?

Have you served in the military?*

YesNo

Employment Status*

EmployedUnemployedStudent

Are you currently employed as a THW, (CRM, PSS, Doula, Community Health Navigator, Etc.)?*

YesNoDon't Know

Do you need written materials in an alternate format (Braille, large print, audio recordings, etc.)?*

YesNoDon't want to answer/DeclineOther

How do you identify your race, ethnicity, tribal affiliation, country of origin, or ancestry?

Social Security Number*

We cannot process the application without this information. Information provided will be kept confidential.

Lived Experience

Per Oregon Administrative Rule (OAR) 410-180-305, The Peer Company provides the following certificates to participants of its Peer Wellness Specialist training program:

• Certificate of completion will be provided to participants who meet all required instruction, demonstrate achievement of all competency requirements, and have life experience as defined in OAR 410-180-305 if applying for Peer Peer Wellness Specialist certification from the Oregon Health Authority. Only a certificate of completion is acceptable proof of training to receive certification from the state.

• Certificate of attendance will be provided to those who attend and participate in the training but do not identify as having lived experience.

Do you identify as being in recovery from mental health challenges?*

YesNo

Do you identify as being in recovery from a behavioral addiction or substance use issue?*

YesNo

Do you identify as having lived experience of having a physical health condition(s)?*

YesNo

Identify any Peer Support training you have received in the past.*

Have you been certified through another Peer Support Specialist or Peer Wellness Specialist training program in Oregon or elsewhere?*

What is the highest level of education you have completed?*

Why do you want to become a Peer Wellness Specialist?*

Do you have any concerns about this line of work or participating in this training?*

How did you hear about our training?*

For VIRTUAL trainings: Do you have access to a tablet, laptop, or desktop computer? (Mobile devices do not allow for full participation throughout training course.)*

YesNoNot Applicable

Does your device have audio and video capabilities?*

YesNoNot Applicable

Do you have access to stable internet connection?*

YesNoNot Applicable

How will you be paying for this training?*

If you are a current employee at The Peer Company, please select your program below.

Other

If you selected "Other" above please list other funder

The Peer Company Employees Only

MHAAO Staff Program

Representative Name

First NameLast Name

Organization/Entity

Funder Email Address

example@example.com

Funder Phone Number

Please enter a valid phone number.

Peer Wellness Specialist Training Application

Please select up to two training options. Do not choose both virtual and in-person in the same month, or any cohort marked FULL.

Education and Training

Supplemental Questions

Funding Information

Payment Information