Peer Specialist Supervisor Training Application (PSS)

Minimum qualifications list can be accessed below. This application is for individuals interested in completing training to become Peer Specialist Supervisors. The PSS training prepares participants to supervise peer roles, support professional development, and uphold recovery-oriented and trauma-informed supervision practices in accordance with Texas standards. Tex. Admin. Code § 354.3105 Peer Specialist Supervisor Minimum Qualifications

"*" indicates required fields

Personal Information

Name*

Please provide your legal name as it will appear on your certificate of completion.

First Middle Last Suffix

Preferred Name

If different from above

First Middle Last Suffix

Email*

Please enter the email address you will use to register and attend the class.

Enter Email Confirm Email

Phone*

Date of Birth*

MM slash DD slash YYYY

Gender*

Male

Female

Transgender (Male to Female)

Transgender (Female to Male)

Gender non-conforming

Prefer Not to Answer

Other

Preferred Language*

English

Spanish

Both

Other

Race and/or ethnicity*

What is your race and/or ethnicity? Please select all that apply.

American Indian or Alaska Native (Individuals with origins in any of the original peoples of North, Central, and South America, including, for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Iñupiat Traditional Government, Nome Eskimo Community, Nahua, and Maya)

Asian (Individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia, including, for example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese)

Black or African American (Includes individuals with origins in any of the Black racial groups of Africa, including, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali)

Hispanic or Latino/a (Includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin)

Middle Eastern or North African (Individuals with origins in any of the original peoples of the Middle East or North Africa, including, for example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli)

Native Hawaiian or Other Pacific Islander (Individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands, including, for example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese.)

White (Individuals with origins in any of the original peoples of Europe, including, for example, English, German, Irish, Italian, Polish, and Scottish.)

Another race or ethnicity (please specify)

Prefer not to answer

Specify other race/ethnicity*

Address*

Applicants must live, or work full-time, in Texas.

Street Address Address Line 2 City State ZIP Code

County (Texas Residents)*

County (If you live outside Texas)

Do you have a high school diploma, GED, or equivalent?*

A high school diploma, GED, or equivalent credential is required for Peer Specialist Supervisor certification. You will be asked to provide documentation (e.g., diploma, transcript, or equivalent).

Yes

What is your citizenship status?*

Your response will not impact your standing with our organization.

U.S. Citizen

U.S. Permanent Resident (green card holder)

Other / Not a U.S. Citizen

Prefer Not To Answer

Qualifications

Check Here to See If You're Qualified

To be eligible for this certification, applicants must be one of the following BEFORE applying to be a Peer Specialist Supervisor:*

1. A Qualified Credentialed Counselor (QCC) 2. A Licensed Practitioner of the Healing Arts (LPHA) 3. A Qualified Mental Health ProfessionalCommunity Supervision (QMHP-CS) with a QCC OR LPHA supervising the QMHP-CS 4. A Qualified Peer Supervisor (QPS) with a QCC OR LPHA supervising the QPS

I am eligible to apply to be a peer specialist supervisor.

I have a copy of my personal QCC or LPHA license and can provide it.

I am eligible because I am a QPS and will need to provide a record of work experience.

I am a QPS and am able to provide a copy of my MHPS or RSPS certificate in order to achieve my certification.

Select all Peer professional certifications you currently hold in Texas.*

Recovery Support Peer Specialist (RSPS)

Peer Recovery Support Specialist (PRSS)

Peer Mentor/Peer Recovery Coach (PM/PRC)

Mental Health Peer Specialist (MHPS)

Certified Family Partner (CFP)

Justice Involved Re-entry Peer Specialist (JI-RPS)

Recovery House Manager

I am not certified in Texas

Not Applicable

File

Drop files here or

Max. file size: 256 MB.

Select all licences that you currently have in Texas.*

Check all that apply

A QCC (Qualified Credentialed Counselor)

A LPHA (Licensed Practitioner of the Healing Arts)

QMHP-CS (Qualified Mental Health Professional - Community Supervision), supervised by a QCC or LPHA

QPS (Qualified Peer Specialist), supervised by a QCC or LPHA

Not Applicable

File

Drop files here or

Max. file size: 256 MB.

Are you a Qualified Peer Specialist (QPS), with a QCC or LPHA supervisor?*

I have achieved a GED or high school diploma, and at least four years of work as a CERTIFIED peer specialist.

I have an associate degree or higher from an accredited university, and at least two years of experience as a certified peer specialist.

Not Applicable

Lived Experience

The following questions help us ensure that applicants meet the requirements for peer specialist roles in Texas. You may answer in whatever style feels safe and true for you.

Demonstrated Lived Experience (Substance Use Recovery)*

Do you have demonstrated lived experience with self-directed recovery from personal substance use issues?

Yes

Prefer not to answer

Other

Demonstrated Lived Experience (Mental Health Recovery)*

Do you have demonstrated lived experience with self-directed recovery from personal mental health challenges?

Yes

Prefer not to answer

Other

Demonstrated Lived Experience (Family)*

Do you have demonstrated personal lived experience with self-directed recovery from the challenges related to a friend or family member's substance use issues and/or mental health challenges?

Yes

Prefer not to answer

Other

Sustained Personal Recovery*

Please describe your pathway to sustained personal recovery.

Storysharing*

Are you willing and able to share your recovery story with others?

Yes

Other

Ethics, Background, and Training History

Ethical Violations*

Have you ever undergone any disciplinary actions for a violation of ethics?

Yes

Disciplinary Action*

Please explain any disciplinary actions taken against you and the violation of ethics.

Completion*

Do you intend to complete your certification steps to become a Texas State Certified Peer Specialist Supervisor?

Yes

Maybe/I don't know

Are you able to pass a criminal history and registry background check?*

A background check is required by the state for certification. A past record does not automatically disqualify you. Applicants must pass criminal history and registry checks as described in TAC rule §354.3201 (relating to Criminal History and Registry Checks)

Yes

Maybe/I don't know

Previous training experience*

Have you ever taken this training before?

Yes

Maybe/I don't know

Refresher*

Are you applying to take this course as a refresher?

Yes

I was certified, and my certification lapsed. I am applying to achieve my certification again.

Other

Accessibility Needs

Equipment*

Do you have access to a computer or laptop that you can use for the duration of the training in a stationary location? *

Yes

Other

Please list any special accommodations you will need to effectively complete this training.*

If you do not require any, please enter N/A.

Motivation & Career Goals

Why are you interested in attending the Peer Specialist Supervisor training?*

Please describe your motivation for attending this course.

Vision*

Tell us about your vision for your future after completing your certification.

Attestation

Post Training Survey

Are you willing to complete a short post training follow up survey?

Yes

Signature*

By signing, I attest that I have completed this application accurately and completely to the best of my current knowledge.