Peer Support Specialist Training Registration

Complete this form to register for the selected training.

First Name *

Last Name *

Email *

Phone *

Organization

Street Address *

Address Line 2

City *

State *

ZIP / Postal Code *

County

Training Class *

Payment Path *

Agency Contact Name

Agency Contact Email

I understand this training is part of the Peer Support Specialist training pathway and does not by itself guarantee certification.

I understand there is an advanced assignment / pre-class work requirement.

I understand attendance and participation requirements apply.

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