Application for Specialty Track Designation

New York Certified Peer Specialists (NYCPS) should use this form to apply for endorsement from the New York Peer Specialist Certification Board (NYPSCB) for completing APS-Approved Specialty Tracks.

Please note that you can only apply for one endorsement per application. For example, if you completed the Older Adult Specialty Track and the Justice Involved Specialty Track, you will need to fill out an application for endorsement for the Older Adult Specialty Track and then complete a second application for endorsement for the Justice Involved Specialty Track.

If an individual’s NYCPS registration has expired or expires within 30 days of this application, the applicant will need to renew their NYCPS registration prior to any endorsements being issued.

Please note that Specialty Tracks do not count as continuing education credits toward certification.

If you are unable to complete this form, you can obtain a paper copy by calling the NYPSCB at 518-426-0945 or emailing nypscb@mhepinc.org.

First Name as it appears on your NYCPS or NYCPS-P certificate(Required)

Last Name as it appears on your NYCPS or NYCPS-P certificate(Required)

Email on file with the NYPSCB(Required)

Peer Specialist Certification Number(Required)

Certification Expiration Date(Required)

Type of Certification(Required)

Provisional

Standard

Which Specialty Track are you applying for?(Required)

Please upload a copy of your APS Transcript.(Required)

Max. file size: 100 MB.

CAPTCHA