Welcome to the online New York Certified Peer Specialist-Provisional (NYCPS-P) application form.
This is a 9 page form created to gather all the information and documentation necessary for NYCPS-Provisional certification for review by the New York Peer Specialist Certification Board (NYPSCB).
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The New York Peer Specialist Certification Board defines a NYCPS - New York Certified Peer Specialist as a person who, by virtue of special knowledge, training, and experience, is uniquely able to inform, motivate, guide, and support persons in recovery from a mental health condition, diagnosis or major life disruption.
In order to become certified as a NYCPS, a candidate must demonstrate they have completed appropriate education and training, relevant to the work of a peer specialist and endorse the NYPSCB Code of Ethical Conduct and Disciplinary Procedures.
For the purpose of certification, a New York Certified Peer Specialist is defined as a person who has demonstrated competence in performing a range of peer support activities as defined in the New York Certified Peer Specialist - Scope of Activities (2015). The scope of activities outlines the range of peer recovery services that a New York Certified Peer Specialist can provide to assist others in living their lives based on the principles of recovery and resiliency.
A. Teach and model the value of every individual’s recovery experience;
B. Model effective coping techniques and self-help strategies;
C. Encourage peers to develop a healthy independence; and
D. Establish and maintain a peer relationship rather than a hierarchical relationship.
A. Understand and utilize specific interactions to assist peers in meeting their individualized recovery.
B. Demonstrate and impart how to facilitate recovery dialogues through the use active listening and other best practice methods;
C. Demonstrate and impart relevant skills needed for self-management of symptoms, relapse;
D. Demonstrate and impart how to overcome personal fears, anxieties, urges, and triggers;
E. Assist individuals in recovery in articulating their personal goals and objectives for recovery
F. Assist individuals in recovery in creating their personal recovery plans (e.g., WRAP®, crisis plan, etc.);
G. Appropriately document activities provided to peers in either their individual records or program records.
A. Reading books, current journals, and other relevant material;
B. Developing and sharing recovery-oriented material with other Certified Peer Specialists;
C. Attending authorized or recognized seminars, workshops, and educational trainings.
A. Providing and promoting recovery-based services (e.g., WRAP®, IPS, etc.);
B. Assisting individuals in recovery in obtaining services that suit each peer’s individual recovery needs;
C. Assisting individuals in recovery in developing empowerment skills through self-advocacy;
D. Assisting individuals in recovery in developing problem-solving skills so they can respond to challenges to their recovery;
E. When appropriate sharing his or her unique perspective on recovery from mental illness and co-occurring disorders with non-peer staff;
F. Assisting non-peer staff in a collaborative process in identifying programs and environments that are conducive to recovery.
In all activities, the peer specialist must demonstrate consistent adherence to the NYPSCB Code of Ethical Conduct (2015) & NYPSCB Code of Ethical Conduct – Disciplinary Procedures (2015) and agree to continue their professional development with ongoing education, training and maintain a working knowledge of current best practices and developments in the field of peer support.
Please read and sign at the bottom
A. I hereby attest that all of the information given is true and complete to the best of my knowledge and belief. I understand that falsification of any portion of this application will result in my being denied certification or revocation of same, upon discovery. I have read and understand the New York Peer Specialist - Scope of Activities (2015) and agree to abide by and operate within the Scope of Activities (2015) adopted by the NYPSCB.
B. I acknowledge the right of NYPSCB to verify the information in this application or to seek further information from employers, schools, or persons mentioned within.
C. I have read, understand, and agree to act in accordance with the NYPSCB Code of Ethical Conduct (2018) and the NYPSCB Code of Ethical Conduct – Disciplinary Procedures (2018) available on the NYPSCB’s website at http://www.nypeerspecialist.org/
D. I will hold NYPSCB, its Board members, officers, agents, and staff free from any civil liability for damages or complaints by reason of any action that is within their scope and arising out of the performance of their duties which they, or any of them, may take in connection with any examination, and/or failure of the Board to bestow upon me certification with the NYPSCB.
E. I understand that upon acceptance of my application, additional fees may be due and payable including exam fees, renewal fees, etc. and that all NYPSCB fees are non-refundable without exception.
I hereby authorize the NYPSCB to request and receive all records and/or information in any way relating to my application for a NYPSCB certification. I understand that this includes, but is not limited to, verbal or written contacts with my employer(s), colleagues, academic and training institutions, and/or other persons or organizations having pertinent information related to the review of my application. This is a waiver of my privilege that may otherwise exist in respect to the disclosure of such information. I understand that this authorization will expire one year after certification lapses or when my certification expires, once NYPSCB is notified of my intent not to renew. I further understand that the status of any NYPSCB certification is public record and may be shared by NYPSCB and is available on the NYPSCB website, including effective date, expiration date and certification type. I further understand that if my NYPSCB certification is sanctioned in any way including revocation or suspension that this information is public.
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My signature affirms that all of the information contained in this application is true and correct to the best of my knowledge. I understand that knowingly providing false information may be grounds to deny or revoke my certification.
The following Academy of Peer Services (APS) training modules are required of NYCPS-P certification.
Please indicate below all of the modules that you have successfully completed: *
*Successful completion means the following:
1. You have successfully completed the training/course for each module according to APS/NYPSCB standards
2. You have passed the post test for each module according to APS /NYPSCB standards
Please include the name and contact information for three references from individuals able to speak to your abilities as a peer specialist, using your recovery skills to support others. Letters should contain specific detail and description of your strengths, skills and abilities that will make you an effective peer specialist.
Please make sure to include the name, phone, email address and your relationship to the reference author.
The reference authors will receive an email with a link to send the NYPSCB a letter of reference on your behalf. However, you should email each reference author directly to notify them you have submitted their contact information to compete a letter and ask them to submit within 7 days to ensure prompt processing of your application.
Letters will not be accepted from:
1) Past or present clinical, medical, case management, or treatment providers
2) Family members
If you have any questions, please contact the NYPSCB office at email@example.com for assistance with letter criteria or submission process.
Please provide reference information. An email will be sent upon final submittal requesting that the Reference Author fills in or uploads a letter of reference.
How to Scan A Document
Once you have an image on your pc, click upload, navigate to your image and upload it.
If you did not obtain your high school diploma, please provide information about your high school equivalency. A high school diploma or equivalency is required in order to become certified.
The certification board requires an image photocopy of your high school diploma or general equivalency document.
We prefer you upload a pdf. However, we only accept the following image types: jpg, tiff, gif, bmp, png or pdf.
There is a maximum size of 10MB for the image upload. Please consult your local library, office supply store or copy center and they can assist to make it smaller.
I affirm that all of the information contained in this application is true and correct to the best of my knowledge. I understand that knowingly providing false information may be grounds to deny or revoke my certification.
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