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Renewal

NYCPS / NYCPS-P Renewal Form

Your Name(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 - 20 HOURS OF PEER SPECIALIST SPECIFIC TRAINING IS REQUIRED

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    YOUR NYCPS / NYCPS-P CERTIFICATION DETAILS

    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
    MM slash DD slash YYYY
    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)

    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 and payment of a $75.00 late fee will be required in order to reinstate my active certification status. PAYMENT OF LATE FEE IS THE RESPONSIBILITY OF CERTIFIED PROFESSIONAL AND WILL NOT BE COVERED BY OMH GRANT FUNDING.
    Consent(Required)