Long Island Peer Specialist Community of Practice (LIPSCoP)

Membership Application

Welcome! Please tell us more about yourself and how you prefer to be contacted.

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* 1. Which of the following best describes you?

I currently work in a peer role.

I am hoping to work in a peer role in the future.

Neither

Comment (optional)

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* 2. If you work in a peer role, or are planning to, which of the following best describes you? Check all that apply.

Peer Specialist (working in OMH-funded/monitored settings)

Recovery Coach (typically working in OASAS-funded/monitored settings)

Youth Peer Advocate (working in settings serving youth/adolescents)

Family Peer Advocate (working in settings serving family members)

Peer Worker (working in DOH-funded/monitored settings, i.e. HIV/Hepatitis/STI prevention)

I don't work in a peer role.

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* 3. Are you certified or credentialed with any of the following? Check all that apply.

NYS Certified Peer Specialist (CPS)

NYS Certified Recovery Peer Advocate (CRPA)

NYS Certified Addiction Recovery Coach (CARC)

NYS Youth Peer Advocate credential (YPA)

NYS Family Peer Advocate credential (FPA)

NYS Certified Peer Worker (via DOH AIDS Institute)

I don't hold any peer certifications/credentials.

Other/Comment (optional)

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* 4. If you currently work in a peer role, can you tell us where you work (organization) and your title?

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* 5. How did you learn about the Long Island Peer Specialist Community of Practice (LIPSCoP)?

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* 6. Which of the following is most important to you as a member of the LIPSCoP?

Access to training and CEUs (Continuing Education Units)

Social Support and Community (connecting with other peer professionals)

Reflective Practice (supportive discussion about actual peer work)

Workforce Development (mentoring, certification support, career development)

Other (please specify)

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* 7. Does your supervisor support and encourage you to attend LIPSCoP meetings?

Yes

Comment (optional)

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* 8. What areas might you be interested in supporting?

Newsletter Committee

Diversity Committee

Training Committee

Events Committee

Not sure - but interested in getting involved

Not interested in committee work at this time

Comment (optional)

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* 9. Use this space for any comments or questions you'd like to share with the LIPSCoP board.

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* 10. Please share contact info to join the LI PSCoP.

Name

Employer (optional)

County (Nassau, Suffolk, or other)

Preferred email (will be visible to other group members)

Phone Number