Renewal

NYCPS / NYCPS-P Renewal Form

Your Name(Required)

First Last

Your Email(Required)

NYCPS or NYCPS-P Two Year Renewal Fee - $100.00 The Renewal fee is currently being funded by NYS OMH for all individuals working or living in New York State. If you do not live or work in New York State, you must submit payment to the NYPSCB prior to processing of your renewal form.

TRAINING CERTIFICATES - 10, 20 OR 30 HOURS OF PEER SPECIALIST SPECIFIC TRAINING IS REQUIRED

10 CREDITS FOR ONE YEAR, 20 CREDITS FOR TWO YEARS, 30 CREDITS FOR THREE YEARS.

UPLOAD TRAINING CERTIFICATES(Required)

Drop files here or

Max. file size: 100 MB.

YOUR NYCPS / NYCPS-P CERTIFICATION DETAILS

Insert the numbers below(Required)

Your certification number is on your certificate on the lower left hand corner. The certificate starts with either NYCPS- or NYCPS-P- and then has a unique number. e.g, 1234. Please enter the number ONLY

YOUR RENEWAL DATE(Required)

Your renewal date is on your certificate just above the certificate number. It is the same date as your certificate exipration date.

YOUR CONTACT INFORMATION

It is your responsibility to ensure the NYPSCB has your updated contact information. If your address, email, phone number or legal name has changed since the issuance of your NYCPS or NYCPS-P certification, please indicate that below. If you do NOT need to change your contact informatio please select the option "I DO NOT need to update my contact information".
If your contact information has changed, please select "I DO need to update my contact information - please email me".

Please select an option below(Required)

I DO NOT need to update my contact information

I DO need to update my contact information - please email me

UPDATE INFORMATION

A current State/Federal issued photo ID is required of renewal. Please upload a legible copy (.pdf or .jpg format only)

Max. file size: 100 MB.

Current Address(Required)

Please provide your current address

Street Address Address Line 2 City State ZIP Code

Current Phone(Required)

NYCPS / NYCPS-P RENEWAL SUBMISSION ACKNOLWEDGMENT

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 form will result in being denied renewal and/or revocation of my NYCPS or NYCPS-P, upon discovery.
I acknowledge the right of the NYPSCB to verify the information in this form or to seek further information as needed in review of my renewal request.
I have read, understand and agree to act in accordance with the NYPSCB Code of Ethical Conduct and Disciplinary Procedures (2015).
I understand that my complete renewal form with supporting documentation is due prior to my renewal date.
I understand that if I do not complete the renewal process prior to my renewal date, my NYCPS / NYCPS-P certification may LAPSE.

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