Peer Worker Training Project

Peer Worker Training Project
The Peer Worker Training Project objective is to deliver accessible behavioral health training, enhance the availability of behavioral services, and strengthen the local behavioral health workforce. Individuals will engage in workforce skills development training then they will take an Oregon Health Authority approved Peer Wellness Specialist training or an approved Peer Support Specialist training.

Applications are reviewed on a first come first serve basis. Once the application has been completed an email confirmation that the application has been received will be sent. Please allow time for processing. If you have any questions please email the Program Coordinator, Mike Nicholas at mnicholas@thepeercompany.org or the OPTIC Program director, Emily Nelson at enelson@thepeercompany.org
Name*

FirstLast
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
County*
Please note at this time this project is limited to people living in Multnomah, Clackamas, and Washington Counties.
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.)*
Black/African AmericanWhite/CaucasianMiddle Eastern/North AfricanHispanic/LatinoAmerican Indian/Alaskan NativeAsianNative Hawaiian/Pacific IslanderOtherDecline to Answer
MaleFemale
ManWomanNon-Binary
YesNo
EmployedUnemployedStudent
If Unemployed Last Date Worked?

MonthDayYear
Date
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Social Security Number*
We cannot process the application without this information. Information provided will be kept confidential.
YesNo
YesNo
YesNo
Education and Training
What is the highest level of education you have completed?*
YesNo
What kind of employment support are you interested in?
YesNo
Supplemental Questions
YesNo
YesNo
Do you have any potential barriers to participate in this peer workforce development program? (If yes, please list)*
If no please list N/A
How did you hear about this opportunity?*
Name of person that referred you*
Email of the person that referred you.*
Online/VirtualIn-personNo Preference
YesNoNot Applicable
YesNoNot Applicable
YesNoNot Applicable
Is there anything else you would like us to know?
This provider is an equal opportunity program/employer. Auxiliary aids are available upon request to individuals with disabilities. TTY 1-800-735-2900. To place a free relay call in Oregon, dial 711.
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Peer Worker Training Project

Education and Training

Supplemental Questions