APPLICATION to ATTEND
Iowa Peer Support Training Academy
Sponsored by:
Waubonsie Mental Health Center
The Iowa Peer Support Training Academy Advisory Committee
Magellan Behavioral Care of Iowa
Congratulations on deciding to apply to attend the Peer Support Training Academy! This
40 hour training will be an excellent opportunity for you to develop and hone your skills as a Peer Support
Specialist and get plugged in with a network of peers who are dedicated to moving peer support to the
next level as a profession in Iowa. Peer providers work from the perspective of their lived experience and
their own recovery journey to assist in educating others about the realities of success, hope, and
empowerment and about the multiple paths to recovery. The training is a partnership with Appalachian
Consulting Group (ACG) and is based on the Georgia Model of Peer Support and will meet the unique
needs of Iowa: Certification of Peer Specialists and Integrating Peer Support Whole Health and Resiliency
into the service delivery system. You will receive a certificate of completion for attending the entire
training which includes a post training examination.
Please be advised:
 Application preference in these training sessions will be given to persons who are currently employed or
have an offer of employment in a Peer Support position through an Integrated Health Home. Other
applicants will be considered for additional openings.
 There will be three separate training locations throughout the state. Applicants can apply to any of the
training sessions based on their personal preference and needs. The training model is one in which
attendees have the opportunity to learn and “live” peer support. Overnight accommodations are provided
and it is expected that attendees will take advantage of the wellness, leisure, and social opportunities this
model offers. Evening study groups, providing peer support to one another, and other networking
opportunities will allow for full “immersion” into the world of peer support.
 Training sessions can accommodate approximately twenty attendees. If you are not accepted to your first
choice training venue, you will be given the opportunity to attend at your second or third choice venue.
 All FIVE days of training with testing on the last day are mandatory in order to receive a certificate of
completion.
 The training is free to attendees. These trainings are being paid for by the Iowa Department of Human
Services through its contract with Magellan Behavioral Care of Iowa for Iowa Plan for Behavioral Health
Medicaid Community Reinvestment.
 Transportation arrangements must be made by the attendee for this training. Mileage is not reimbursed by
the training sponsors but may be available through your employer. Car-pooling anticipated and facilitated.
Please provide at least two letters of support with your application
It is recommended that you seek letters of support from your colleagues and supervisors involved in
mental health organizations, to include but not limited to advocacy organizations, community mental
health centers, recovery centers, drop-in centers, 12-step programs, and other groups focused on recovery.
Letters of support could include the following:
· Describe the applicant’s strengths that they would bring to the field as a Mental Health Peer Support
Specialist.
· Provide examples of the applicant’s involvement in recovery-based mental health or other initiatives and
activities (i.e. self-advocacy, leadership in mental health programs and services, training, lived experience,
etc.).
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· The author may want to describe his or her familiarity with Peer Support Training, Peer Support Services
and Integrated Health Homes.
· Describe the applicant’s readiness to attend and fully participate in the training.
Dates of Training:
Please choose (on page 3) a first choice, second choice and third choice location/venue. Accommodations are
provided beginning Monday night through Thursday night. Meals are also provided. Logistical details vary
for each venue and will be provided to attendees prior to the training.
Monday, June 2nd – Friday, June 6th
Prairiewood Franciscan Spirituality Center, Hiawatha, Iowa
Prairiewoods is a place to restore connections between humans and
Earth. Located in northeast Iowa, on 70 acres of natural beauty, the
center combines spirituality with care for the Earth. Prairiewoods’ 70
acres of woods and prairie offer a haven for those in search of quiet,
solitude and a connection with the natural world. Many who come to
Prairiewoods talk of receiving an instant sense of peace or of
experiencing healing energy as they enter the grounds.
http://prairiewoods.org/
Monday, July 28th – Friday, August 1st
Creighton University Retreat Center, Griswold, Iowa
The Creighton Retreat Center is a quiet, peaceful place that
touches the heart and moves the soul. The comfortable facilities
and hospitable environment are set in 157 acres of wooded area
along a river teeming with wildlife, song birds, hiking trails and
an awesome night sky.
http://www.creighton.edu/ministry/retreatcenter/
Monday, September 22nd – Friday, September 26th
Iowa Western Community College, Clarinda, Iowa (hotel accommodations)
Experience the only Iowa community to be designated as “One of the Top 10
Best Small Towns in America” by Travel Holiday magazine. Clarinda is
home to the Glenn Miller Birthplace Museum, The Clarinda Treatment
Complex, the Clarinda A’s Collegiate Baseball Team, and the historical
Goldenrod School, birthplace of 4-H. Clarinda is also the location of one of the
first and most successful Peer Support Recovery Centers in Iowa.
http://www.clarinda.org/home_page.htm
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My training venue/location choices are as follows:
First Choice:
Second Choice:
Third Choice:
Contact Information:
Name:
Agency name:
Current status: (Check all that apply)
I work here
I volunteer here
Other
Current job title:
Work telephone:
Work/volunteer address:
Work e-mail:
Home Address:
Home e-mail:
Home Telephone Number:
Cell Phone:
Emergency Contact (used only if necessary while you are attending training)
Name:
Phone:
Gender:
Male
Are you 18 years of age or older?
Female
Yes
No
What is the highest level of education you have completed?
8th grade or less
Some High School
High School graduate or GED
Some technical school or college
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Technical school graduate or Associate Degree
College graduate
Postgraduate or professional degree
Name of High School or College or University (if applicable):
Year of Graduation:
Degree(s) awarded and area of study:
Understanding and Interest: If you need additional space for your answers, please use the back page as necessary.
1. Why do you want to attend this training?
2. What makes you a good candidate to work with people experiencing trauma, mental health and/or substance
abuse challenges in the behavioral health field?
3. What are your strengths and skills that you could utilize as a Peer Provider?
Recovery/Advocacy Experience:
4. What does recovery mean to you?
5. What were/are important factors in your own recovery and/or wellness?
6. What types of experiences have you had in assisting or advocating for persons with mental illness, substance
abuse and/or other disabilities (for example support group leadership, self-advocacy, public testimonial, letter
writing, program start-up)?
7. What will be your most difficult challenge in attending this training? How will you deal with this challenge?
8. Please list other relevant trainings, workshops or conferences you have attended. Include topics covered and
approximate dates of the trainings.
9. Describe your current employment situation (or volunteer situation). If neither applies, how do you spend your
time?
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10. Is there anything else you would like us to know in considering you for this training opportunity?
Personal Commitment
The Peer Support Training requires a significant commitment of time and energy. The initial commitment involves a fiveday program. Please consider your ability to commit time and energy to this project before applying.
Please initial each expectation as an indication that you understand and agree to these requirements:
____I understand that attendance at all sessions is mandatory. NO EXCEPTIONS will be made.
____I commit to participate in the training to the fullest extent of my abilities.
____I agree to self-identify as a person with mental health issues/trauma who is in recovery and I agree to share or
learn to share my recovery story with others
____I commit to becoming actively engaged in mental health advocacy activities in my local community and/or at the State
level.
____I commit to maintaining contact with the training sponsor, Waubonsie Mental Health Center, for the duration of the
grant period (through March 2015) and providing feedback as requested, regarding how I use my training following
completion of the training program.
____ I commit to the completion of all coursework, reading, and homework that is given to me throughout the training.
____I understand that attendance at the training does not guarantee employment.
____I understand that this training meets the training requirements for certification as a Mental Health Peer Support
Specialist. In order to become certified, however, I must also meet the work requirements and pass a certification exam as
outlined by the Iowa Board of Certification.
____I attest that all answers in this application are true to the best of my knowledge.
Please check those that apply to you:
My lived experience is with:
____ Recovery from mental illness only
____ Recovery from substance abuse only
____ Recovery from Co-occurring (mental illness/substance abuse disorder)
____ Recovery from Trauma
____ It has been at least one-year since I was diagnosed with a behavioral health issue/trauma
____ I completed this application on my own. If not, please describe the assistance you received to complete this
application.
Signature and Date: _______________________________________________________
Accommodations
Please let us know if you request any disability related accommodations and tell us what accommodations you request.
Please let us know if you have any special dietary needs.
Return Application, Letters of Support and any request for accommodations to:
Jennifer Herrington
1800 N. 16th Street, Suite 1
Clarinda, Iowa 51632
Fax: 712-542-2984
Phone: 712-542-2388
Jennifer@waubonsiemhc.com
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All application materials should be received four weeks prior to the session for which you are seeking admission. Indicate
the training location you prefer in order of preference. If your preferred session is full at the time your application is
received, you may be able to attend the training in another location. Applicants are encouraged to submit their application as
soon as possible. It is anticipated that these trainings will fill quickly. Applications can be submitted by e-mail, by fax or by
mail. Thank you for your interest and enthusiasm and for all the work you have done and will continue to do. Good luck
with your application!
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