Peers Advancing Total Community Health (PATCH) Application : ICAADA

The Peers Advancing Total Community Health (PATCH) program seeks to expand the public health workforce in Indiana by training new, and existing, peer recovery coaches with specialized training. The program’s goal is to provide training so that participants become newly credentialed Certified Addiction Peer Recovery Coaches (CAPRC) through ICAADA.

Scholarship eligibilty requirements:

Personal lived experience of recovery from substance use for minimum one year
18+ years old
Legal resident of Indiana
Have High School diploma or equivalent

The scholarship award provides financial support to complete the following:

Trainings:

CCAR Recovery Coach Academy (5-days)
MHAI SWD Training Institute Peer Recovery Ethics (2-days)
HIV Education and Risk Reduction (1-day)
Cultural Competency (1-day)

Certification as Certified Addiction Peer Recovery Coach (CAPRC):

ICAADA Membership Fee
CAPRC Certification fee
CAPRC IC&RC Peer Recovery Exam fee

PATCH is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as a part of an award totaling$2,623,630. The contents are those of Mental Health America of Indiana’s (MHAI) and do not necessarily represent the official views of, nor an endorsement by HRSA, HHS, or the U.S Government.

Section 1

Name *

First

Middle

Last

Pronouns *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

County *

Date of Birth *

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Phone *

Email *

What is your primary language? *

Do you speak any additional languages? (If so, please list)

Race (select all that apply) *

American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American. A person having origins in any of the black racial groups of Africa.
Hispanic, Latino or Latine. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Other. Race not listed
Prefer not to disclose

If you answered "Other. Race not listed" above, please fill in your race here.

Ethnicity *

Are you a legal resident of Indiana? *

Section 2

Are you currently employed? *

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Have you or a family member served in the U.S. Military? (Check all that apply) *

I have served in the military.
I have a family member who has served in the military.
None of the above.

If you have served in the military, are you active/reserves or a veteran? *

Active
Reserves
Veteran
I have not personally served in the military

Section 3. Help us better understand who you are as a person.

Do you identify as a person in recovery from substance use? *

Please share why you are interested in becoming a peer recovery coach. *

Have you ever been certified as a Peer Recovery Coach or other type of certified/licensed professional? *

Do you have experience working in a primary care setting? *

Do you have experience working in a behavioral health/mental health/substance use setting? *

Do you have experience working alongside underserved/marginalized communities such as rural areas, racial/ethnic populations who do not represent the dominant culture, LGBTQIA+, lower socio-economic statuses, persons with disabilities? *

If you were referred by someone, please list their name and contact information. *

Section 4. Help us understand your your career aspirations and goals?

How will the peer recovery coach credential you receive from this scholarship opportunity move you closer to your career aspirations or goals? *

Help us understand where you see yourself in one/five/ten years by earning this credential. *

Help us understand how obtaining the peer recovery coach credential will have a positive impact on the community where you will provide services. *

Help us understand why this financial assistance is requested. Please include a reasoning why you are unable to pay the fees yourself. *

Please share any potential barriers you see related to completing all required trainings and actions related to certification. *

Are you interested in learning more about PATCH's Department of Labor certified CAPRC Apprenticeship? *

Yes
No
Unsure

Please list 2 personal and/or professional references that can attest to your character and recovery status (Name, email address, relationship with person) *

Section 5

I understand that a requirement of acceptance of the Peers Advancing Community Total Health (PATCH) scholarship, I must complete the following trainings and credentialing items:

1. CCAR Recovery Coach Academy (virtual training): 5-day course, Monday - Friday course (9am - 4:30pm)

2. Peer Recovery Ethics (virtual training): 2-day course held on consecutive days Monday - Friday (9am - 4:30pm)

3. HIV Education and Risk Reduction (virtual training): 1-day course held Monday - Friday (9am - 4:30pm)

4. Cultural Competency (virtual training): 1-day course held Monday - Friday (9am - 4:30pm)

5. Complete CAPRC application process that includes passing the IC&RC Peer Recovery exam.

6. Participation in monthly Continuing Education Webinars

Completion of this application does not constitute an agreement for scholarship award. Each application will be considered individually. The IAPRSS Peer Innovation Manager will notify you of your application status. If selected, you may be contacted for a phone interview.

I agree I have the means (time commitment, childcare, time off work etc.) to attend all the required training courses and complete all items related to certification.

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Signature *

Date *

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2,623,600 with 0% funded by non-government sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.

Scholarship eligibilty requirements:

Trainings:

Certification as Certified Addiction Peer Recovery Coach (CAPRC):

Section 1

Section 2

Section 3. Help us better understand who you are as a person.

Section 4. Help us understand your your career aspirations and goals?

Section 5

Earn credentials to treat and/or support individuals with behavioral health conditions.