Reference Submission

Name(Required)

First Last

Email(Required)

Please describe the nature of your relationship with the applicant.(Required)

Explain how long you have known the candidate.(Required)

Please give specific detail and description of the strengths, skills and abilities of the applicant that will make them an effective peer specialist.(Required)

Explain how you have observed the applicant use their own recovery to support others.(Required)

Any other information you would like the NYPSCB to consider in reviewing their application.

Signature(Required)