Wisconsin Certified Peer Specialist Recertification Application

Apply for recertification as a Wisconsin Certified Peer Specialist (CPS). Applications, along with documented continuing education hours, and payment must be submitted no later than August 30th in the year your recertification is due. Completing the Application for Recertification as a WI Certified Peer Specialist Please fill out this Application for Recertification in full. Submission of this form by the relavant recertification deadline is a required step for recertification as a Certified Peer Specialist in Wisconsin. Recertification applications and the $55 fee are due by August 30th every two years from the year you passed the exam or last recertified. All required fields in this application are marked with an asterisk (*). Your Information

"*" indicates required fields

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Primary Phone Number*

Secondary Phone Number

Email Address*

Confirm Email*

Please select your county of residence.*

If you are a member of a tribal nation of Wisconsin, please select your tribe.

Lived Experience

Select the lived experiences specific to the CPS role with which you identify:

Experience with social, emotional, behavioral, mental health challenges

Experience with substance use challenges

Continuing Education Hours Report The Wisconsin Peer Specialist certification is valid for two years. In this two-year period, 20 total hours of continuing education hours (CEH) and/or continuing education units (Complete your 20 continuing education hours (CEHs) with a minimum of 1.5 hours in each of the recertification CEH topic areas (cultural humility, ethics and boundaries, substance use-specific, mental health-specific, trauma-informed care, and peer specialist-specific). The remaining 12.5 hours may be in any category of your choosing as it relates to the parent peer specialist role. The conversion rate for CEU/CEH is: .1 CEU = 1 CEH. Independent reading does not qualify as continuing education. Organized study groups with specific learning objectives, and facilitated by trained individuals with direct knowledge of the content discussed may count for continuing education hours. In this case, it is recommended that the curriculum and trainer biography be submitted to the WIPSEI Peer Specialist Program Coordinator for approval.

WI CPS Continuing Education Hours Report * All CPS must document at least 20 hours of continuing education for recertification purposes. Please use this space to document educational hours completed during the period between certification/last recertification date and your current recertification due date. You must have at least 1.5 hours in each required topic area. Please do not submit copies of certificates.

Event Name	Host Name	Event Date	Speaker Name	Training Hours	Topic

Assurances

Please indicate the statements below that are true for you:*

I understand that submitting the Continuing Education Hours information is required, and these hours will be reviewed for completeness.

I understand that the Wisconsin Peer Specialist Employment Initiative will conduct periodic audits for CPS/CPPS, and I must keep all documantation or certificates associated with my continuing education hours for two years after recertification.

I understand that if I did not submit an online payment, my $55 recertification fee payment will need to be postmarked by the recertification deadline.

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.

Optional Employment Questions The Wisconsin Peer Specialist Employment Initiative seeks to support the continued development of the Certified Peer Specialist and Certified Parent Peer Specialist workforce. Please answer the following questions if you are able. Your answers will help to better inform the expansion of the CPS/CPPS workforce, professional development opportunities, as well as employer supports and technical assistance. You do not have to answer these questions to submit the application.

Are you currently employed as a Certified Peer Specialist, in a related peer support role, or in a leadership or supervisory role to CPS staff ?

Yes

What issues do you feel are most important for CPS today, and how would you feel better supported in your role, both in the workplace and in the community?

Digital Signature (Type Full Name)*