Wisconsin Certified Peer Specialist Exam Application I have successfully completed course number:(Required)CertificateA copy of the certificate of successful completion of this training must be included with this application. If you have a digital copy (PDF or image file) of certificate, you may upload it here. Otherwise a copy must be mailed with payment.Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB. By applying for this certification, I agree to abide by the WI Certified Peer Specialist Code of Ethics.Name(Required)Address(Required) Street Address City State / Province / Region ZIP / Postal Code CountyAdamsAshlandBarronBayfieldBrownBuffaloBurnettCalumetChippewaClarkColumbiaCrawfordDaneDodgeDoorDouglasDunnEau ClaireFlorenceFond du LacForestGrantGreenGreen LakeIowaIronJacksonJeffersonJuneauKenoshaKewauneeLa CrosseLafayetteLangladeLincolnManitowocMarathonMarinetteMarquetteMenomineeMilwaukeeMonroeOcontoOneidaOutagamieOzaukeePepinPiercePolkPortagePriceRacineRichlandRockRuskSaukSawyerShawanoSheboyganSt. CroixTaylorTrempealeauVernonVilasWalworthWashburnWashingtonWaukeshaWaupacaWausharaWinnebagoWoodTelephone with Area Code(Required)Email Address(Required) Date of Exam:(Required)Select Exam Date…January 20, 2027March 10, 2027May 5, 2027Is this a Retake?YesNoI originally took the exam on (date): Month Day Year Exam Location All exams are currently online/remote. The exams are not hosted at independent living centers. Optional Demographic Questions We ask these optional questions to gather demographics information related to those applying for recertification as CPS and CPPS. You do not have to answer these questions to submit the application. This information will not impact your ability to recertify.Age Range 18-24 25-34 35-44 45-54 55-64 65+ Highest Level of Education Completed High School or GED Some College Associate’s Degree Bachelor’s Degree Master’s Degree Doctoral Degree What describes your gender? Please check as many as apply. Man Woman Nonbinary Transgender Intersex Prefer not to say Other If you selected "Other" for gender, please specify.What pronouns do you ask others to use when referring to you? he, him, his she, her, hers they, them, theirs no pronouns (just use my name) other If you selected "Other" for pronouns, please specify.How would you describe yourself in terms of race or ethnicity? Please check as many options as apply. American Indian or Alaska Native Asian Black or African American Hispanic Latinx Native Hawaiian or Other Pacific Islander White Prefer not to say Other If you selected "Other" for race or ethnicity, please specify.Are you (or do you identify as) any of the following? LGBTQIA+ Disabled or Having a Disability Low Income Immigrant Military Veteran Formerly (or currently) Incarcerated Formerly (or currently) Homeless/Houseless Prefer not to say None of the above Other If you selected "Other" to the last question and there is any other aspect(s) of your identity or lived experience that you would like to share, please specify.By filling out this application and retuning it according to the directions, you will be signing this form and acknowledging that all enclosed statements are true and accurate. Signature By submitting this form, you are signing and confirming the below: I am paying online with Credit Card/Debit card or mailing a check or money order for $60 out to UW-Milwaukee School of Continuing Education. I have read and agree to the WI Certified Peer Specialist Recertification requirements. I have read and am familiar with WI Certified Peer Specialist Code of Ethics, Core Competencies and Scope of Practice. I have either uploaded a copy of the certificate of successful completion of the required training or I am mailing a copy. Digital Signature (Type full Name)(Required)