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- Peer Support Certification Application - General

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Peer Support Canada
Application for Certification as a Peer Supporter Page 1
In this Application Package:
1. Applicant Information
2. Criteria for Application
3. About You
4. About Your Experience
5. References
6. Next Steps
Peer Support Canada
Application for
Peer Support Certification
Peer Support Canada
Application for Certification as a Peer Supporter Page 2
Please note that all information is kept confidential by Peer Support Canada
1. Applicant Information
Date
Name
Address,
City, Province
Postal Code
Email
Preferred
Phone #
Alternate
Phone #
2. Criteria for Application
Do you have personal lived experience*?
Yes ☐ No ☐
Do you believe you are on a path of recovery and wellness, and able to support others?
Yes ☐ No ☐
Do you have experience in delivering at least 200 hours of formalized peer support** with a
focus on supporting a peer in their recovery process?
Yes ☐ No ☐
c I understand that the fees are as follows: $90 Application, $440 Exam, $750 Practicum
c I understand that a practicum is the 3
rd
stage of the Certification process
c I understand the Certification process typically takes 12-24 months to complete
*Lived experience with a mental health challenge and/or a substance use disorder.
**Formalized peer support occurs within a peer support setting or program and can be either paid or
volunteer. Peer support of a formalized nature assumes that a peer supporter will learn how to ensure that
the critical aspects of hopefulness, recovery-orientation, empowerment, non-judgemental acceptance, and
trust are promoted within the peer support relationship. -MHCC (2013). Guidelines for Practice
and Training of Peer Support. (p.18).
Peer Support Canada
Application for Certification as a Peer Supporter Page 3
3. About You
Use as much space as you’d like – text boxes will expand as you type.
1.Why are you interested in Peer Support Canada’s Peer Supporter Certification?
2. What do you hope to get out of this process?
3. What does recovery mean to you personally?
4. What strengths / gifts do you bring to peer support?
Peer Support Canada
Application for Certification as a Peer Supporter Page 4
4. About Your Experience
Tell us about your experience as it relates to peer support. Use as many pages as you need. As part of
the assessment process, Peer Support Canada will be in touch with the organizations to confirm your
acquired experience. This helps us design your practicum.
Most recent role
Organization Name:
City, Province:
Type of Organization:
EG: Clinical site, Community organization, Workplace (providing peer support to colleagues), Other (please
describe)
Contact Name at Organization: Phone #
Contact Email:
Start Date:
End Date:
No. of years and months providing peer support at this location (only fill in applicable lines):
Years
Months
Years
Months
Years
Months
Please provide an approximate % breakdown on how much time was spent on each of the
following
One-on one peer support (relationship building)
%
One-on-one peer support (occasional/drop in)
%
Group Facilitation
%
Community of Practice/Networking
%
Administration
%
Other:
%
Briefly describe your role(s) and responsibilities:
Please elaborate on the one-on-one peer support you provided:
Peer Support Canada
Application for Certification as a Peer Supporter Page 5
2
nd
most recent role
Organization Name:
City, Province:
Type of Organization:
EG: Clinical site, Community organization, Workplace (providing peer support to colleagues), Other (please
describe)
Contact Name at Organization:
Contact Phone Number:
Contact Email:
Start Date:
End Date:
Number of years and months providing peer support at this location (only fill in applicable lines):
on a full-time basis (30+ hrs per week)
Years
Months
on a part-time basis (12-29 hrs per week)
Years
Months
on a casual basis (less than 12 hrs per week)
Years
Months
Please provide an approximate % breakdown on how much time was spent on each of the
following
One-on one peer support (relationship building)
%
One-on-one peer support (occasional/drop in)
%
Group Facilitation
%
Community of Practice/Networking
%
Administration
%
Other:
%
Briefly describe your role(s) and responsibilities:
Please elaborate on the one-on-one peer support you provided:
Peer Support Canada
Application for Certification as a Peer Supporter Page 6
3
rd
most recent role
Organization Name:
City, Province:
Type of Organization:
EG: Clinical site, Community organization, Workplace (providing peer support to colleagues), Other (please
describe)
Contact Name at Organization:
Contact Phone Number:
Contact Email:
Start Date:
End Date:
Number of years and months providing peer support at this location (only fill in applicable lines):
on a full-time basis (30+ hrs per week)
Years
Months
on a part-time basis (12-29 hrs per week)
Years
Months
on a casual basis (less than 12 hrs per week)
Years
Months
Please provide an approximate % breakdown on how much time was spent on each of the
following
%
%
%
%
%
%
Briefly describe your role(s) and responsibilities:
Please elaborate on the one-on-one peer support you provided:
Peer Support Canada
Application for Certification as a Peer Supporter Page 7
5. References
As a part of this application process, Peer Support Canada will contact references who
can speak to your innate qualities and natural skills that indicate your suitability for peer
support work.
We ask that you provide the names and contact information 3 to 5 individuals who
agree to be a reference for you. We will contact your references by email and ask them
to complete an on-line questionnaire and comment on your interpersonal demeanour
and readiness to support others. These references do not need to know anything about
peer support. These questionnaires are designed to assess basic peer support
competencies (such as Demeanour, Interpersonal skills, and Hopeful outlook).
Evidence of these competencies are required in order to proceed through to the
certification process.
For more information about competencies refer to the Peer Support Canada
Certification Handbook.
The amount of time expected to complete this questionnaire is approximately 30
minutes.
We suggest that references might include:
• someone who has been in a supervisory or mentor-type role for you, or
• someone who has worked with you whether it be paid work or voluntary
Please note that:
• individuals to whom you have provided peer support may not be used as a
reference
• members of your family may not be used as a reference.
You will also be asked to complete an on-line self-assessment in order to reflect upon
your own qualities and skills.
At the end of Phase One, the results of the assessment will be shared back with you.
The request will be sent via email – please be sure that the email
addresses of your references are up to date, and that they are available to
complete the assessment.
Peer Support Canada
Application for Certification as a Peer Supporter Page 8
Reference #1
Name
Relationship to you
Phone Number
City, Province
Email
Has this person agreed to be a reference? (Yes/No)
Reference #2
Name
Relationship to you
Phone Number
City, Province
Email
Has this person agreed to be a reference? (Yes/No)
Reference #3
Name
Relationship to you
Phone Number
City, Province
Email
Has this person agreed to be a reference? (Yes/No)
Reference #4
Name
Relationship to you
Phone Number à
City, Province
Email
Has this person agreed to be a reference? (Yes/No)
Reference #5
Name
Relationship to you
Phone Number à
City, Province
Email
Has this person agreed to be a reference? (Yes/No)
Peer Support Canada
Application for Certification as a Peer Supporter Page 9
6. Next Steps
Thank you for taking the time to complete this application. Please keep a copy for your records.
Your application will be viewed by members of the Peer Support Canada Certification
Committee and staff. The contents of your application will be kept confidential by Peer Support
Canada.
To submit by email, save this file as lastname firstname application and email to:
certification@peersupportcanada.ca
The Application Fee is $90 ($101.70 with tax)
c
c
Please invoice me
Please invoice my employer/other
Name:
Email and Phone:
If you have any questions at any time, please contact us at certification@peersupportcanada.ca
You can expect to hear back from us in 6-8 weeks about the status of your application.
Following this phase, you will be invited to complete the Knowledge Assessment. Feedback on
your Knowledge Assessment will be shared back with you, including areas of strength and
areas for development.
The final phase is the Practicum, which is 5-20 weeks (about 10 hours a week) at a location of
your choosing. You will be matched with a mentor who will guide your practicum. (Most people’s
practicum hours are completed as part of their existing work or volunteering.)
Following completion of the practicum there is a final assessment, including feedback from
those you’ve provided peer support to, your Practicum Mentor, and site supervisor. The
Certification Committee makes all recommendations for Certification.
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Completed 15 April 2022

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