Registration Form for the Peer Services in Crisis Care Training Program 40-Hour

  • Registration Form for the Peer Services in Crisis Care Training Program 40-Hr

    Thank you for your interest in WERC’s Peer Services in Crisis Care Specialization Training Program! Please complete this form to register.
  • Enrollment Date
     - -
  • Training Start Date
     - -
  • Training Completion Date
     - -
  • CalMHSA certification issue date
     - -
  • 0/32768

  • Additional Request

  • Accommodation Needed
  • Office Hours Appointment
  • Date of Request
     - -
  • Appointment Date
     - -
  • Cancellation
  • 0/32768
  • Date of Request
     - -
  • Cancellation Approval Date
     - -
  • Leave of Absence
  • Date of Request
     - -
  • Approval Date
     - -
  • Training Program Extension
  • Date of Request
     - -
  • Training Completion Date
     - -
  • Extension Date
     - -
  • 0/32768
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • When did you receive your CalMHSA Peer Support Specialist Certification?*
     - -
  • At this time, WERC is offering the training in English. WERC may offer training in additional languages in the future. If you would like to be placed on a list to learn about a future training offered in a different language, please check this box, complete the rest of this form, and click Submit. Thank you again for your interest in WERC’s Medi-Cal Peer Support Specialist Certification Training Program!*
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Non-voucher Holder

  • Please list your employer's (or sponsoring organization's) accountant information. WERC will follow up with an invoice to process payment with your employer.

    If you are paying it out of pocket, please put in your name and details below.
  • Format: (000) 000-0000.

  • WERC is committed to supporting an inclusive learning environment. Eligible participants may request reasonable accommodation. WERC will determine on an individual basis if accommodation can be provided. To make a request, please contact the WERC team at mpssc@we-rc.org. 

  • WERC's Medi-Cal Peer Services in Crisis Care Training Program is a self-paced 40-hour online course. You will have 6 months to complete the training from the date of registration. 

  • WERC is an equal opportunity training organization committed to diversity, equity, and inclusion. We are excited to offer a training program for peer specialists with lived experience in areas such as housing instability, justice system involvement, substance use disorders, mental illness, and other areas. 

  • Clear
  • Should be Empty: