Name: KY Family Peer Support Core Competency Training
Start: 2021-10-11
End: 2021-10-15
Location: Virtual

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Birth Date*

Phone*

Email*

Enter Email Confirm Email

Organization Name (if Applicable)

Supervisors Name (if Applicable)

Supervisors E-mail address (if Applicable)

Please list your child’s diagnosis/diagnoses and describe any state-funded services they are receiving or have received (see definitions of state-funded services, below) Explanation/Clarification of Terms:*

Explanation/Clarification of Terms: Disability: an emotional, social, behavioral, and/or substance use disability that is defined in the current version of the Diagnostic and Statistical Manual for Mental Disorders (DSM). State-funded Services: To qualify for the position of Kentucky Family Peer Support Specialist (KFPSS), there must be or have been a connection between the youth’s disability/diagnosis and receipt of at least one state-funded service. Examples of state- funded services include: Kentucky IMPACT, Special Education Services, Court Designated Worker or Public Defender, services offered through a Community Mental Health Center, private child care, crisis stabilization units, or residential treatment program. These services could be provided from a variety of child-serving agencies such as: Administrative Office of the Courts; Department for Juvenile Justice; Department of Education; Department for Public Health; Department for Community Based Services; Department for Behavioral Health, Developmental and Intellectual Disabilities; Family Resource or Youth Services Centers.

Why do you want to become a Kentucky Peer Support Specialist (KFPSS)?*

What are your current responsibilities as a full-time caregiver and/or employee?*

Describe any volunteer work you have been involved in (some examples are: PTA president, Scout Leader, Habitat for Humanity, Neighborhood Association, Sunday School/Youth Leader).*

What makes you a good candidate to work with other parents and caregivers of children with mental health/substance use challenges?*

Why do you think it is important for Kentucky Family Peer Support Specialist to share their experiences?*

What does family-driven and youth-guided mean to you?*

Briefly describe the most valuable assistances/support you have received as a parent/caregiver.*

This question explores your experiences or observations about team/group work.What are some of the advantages of being part of a team?*

b. What are some of the disadvantages to being part of a team?*

Is there anything else you would like us to know in considering you for the Core Competency Training?*

Provide the following information by indicating “yes” with a CHECK mark.*

Upload Files, Diploma etc. (Optional)

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Max. file size: 50 MB.

Payment Option*

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Credit Card
Please send me an invoice for my Employer to pay
Need to apply for a Partial Scholarship

Make Checks payable to Kentucky Partnership for Families and Children, Inc. Mailing address: 600 Teton Trail - Frankfort, KY 40601

Family Peer Support Certification Training

Price: $300.00

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$0.00

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kypartnership.org

KY Family Peer Support Core Competency Training

You must complete the Kentucky Family Leadership Academy prior to attending the Family or Youth Peer Support training.

Family Peer Support Core Competency Training Application - October 11th - 15th, 2021

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