Peer Specialists

Peer Specialist Form

Only peer specialists that have completed training and are certified may be listed. If that is you, we would like to have you in the site listing. The area will be organized by region so providers can easily search candidates. And, publicized on our member sites and to partner organizations.

First Name:

Last Name:

I ONLY want my first name listed on the Web site.
Yes:

In what county of the state do you reside?


Date that you received certification?
Month: Year:

Are you open to employment outside of your county?
Yes: No:

How can employers contact you? (You can provide information for all three options.)
Phone:
Email:
Mailing Address:

Please provide a brief summary of your experience.
All of the information provided in this form will be listed on our Web site. If you do not prefer to provide a summary, you can write “Please contact me for more information.”
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