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International Reentry Peer Support Certification Application

Via hope has launched its International Reentry Peer Support Credential and we are pleased to now be accepting applications. The prerequisite is that you must have your JI-RPS certification to be eligible to apply for your International Certification. This application does not guarantee your acceptance. Via Hope staff will be in contact if you are accepted with next steps. This accreditation will be able to be utilized worldwide.

IRPS Certification Application

Step 1 of 5

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Contact Information:
Name:*
First M.I. Last
Home Address:*
Street Address City State ZIP Code
Preferred Email Address:*
Preferred Phone:*
Candidate Eligibility Checklist:*
- I am 18 years or older.
- Completed the Core training (Texas Residents Only)
- I have a High School Diploma or GED. Documentation will be required when applying for certification.
- I have internet and computer access for eLearning training and the certification exam.
- I myself completed this application.
- I have been confined to a JAIL or PRISION as an adult.
- I have experienced a mental health, substance use or co-occurring challenge.
- It has been 1yr or more since my latest incarceration.
Applicant must meet all requirements in order to be accepted into training.

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Recovery and Work Experience
Date of Core training, if in Texas?
1. Do you currently hold any type of peer certification? If so what type?*
2. Do you currently hold a paid peer support position?*
- Yes
- No
3. Do you currently volunteer as a peer position?*
- Yes
- No
4. Name of Employer:*
5. Employer Type:*
6. Employer Address:*
Street Address Address Line 2 City State ZIP Code
7. My Job Title:*
8. My responsibilities include:*
9. If not currently employed, are you actively seeking work as a peer specialist?*
- Yes
- No
- NA

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10. What is your concept of the role of a Reentry Peer Specialist (RPS)?*
11. Why do you want to be a Reentry Peer Specialist?*
12.What was your largest barrier to reentry from incarceration?*

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Participation Requirements Checklist*
- I will attend and actively participate in the full eight days of training online
- I will confirm with both Via Hope and the trainers, in advance, if I need to be absent.
- I understand that Via Hope allows up to four (4) hours maximum absence for emergencies only. Via Hope reserves the right to deny request.
- I understand that if I do not confirm my absence with the trainers and Via Hope in advance I may not be eligible to complete the training and sit for the certification exam.
- I will participate in discussion and role-plays utilizing my personal experiences and sharing my reentry recovery story.
- I understand that I am not guaranteed employment or a volunteer position as a result of participating in this training.
- I agree to take the online certification exam within 72 hours of completing training.

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Are there reasonable accommodations for a disability needed (either for the training or certification exam)?*
- Yes
- No
If so, please describe:
Signature:*
By signing this application I acknowledge that upon passing the required certification examination employers and others can verify my certification status through the Via Hope website. Via Hope reserves the right to determine participation in our training and certification.
Date:*
MM slash DD slash YYYY
Gender:
Age Group:
- 18-25
- 26-35
- 36-55
- 55+
Race/Ethnicity:
Check all that apply.
- African American
- Asian or Pacific Islander
- Indian/Native American
- White
- Other
Are you either an Active Member or Veteran in the Armed Forces?
- Yes
- No
Hidden
Fee*
Fee*
Original Training Name:*
Original Training Date (Month/Year)*
Name of Organization Paying for Training:*
Email Contact at Organization:*

This is the person to whom an invoice will be sent
TWC/TWS Counselor Name:*
TWC/TWS Counselor Email:*
Service Authorization Number:*

Your Service Authorization Number can be obtained from your TWC/TWS counselor.
Payment Type*
!!! IMPORTANT !!!

After you click submit, you will be taken to Paypal to complete your transaction. Be sure to proceed with that payment process to complete your registration. If you encounter any difficulties as you do this, please let us know.
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
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Email
This field is for validation purposes and should be left unchanged.

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