VT2: Virtual Certified Peer Counselor Training

Full legal name (please make sure it matches your Government issued ID)

Last

First

Email

Personal Email (if different from the above)

Phone

Mailing Address

City

State/Province

Zip/Postal

What is your chosen name?

Your Preferred Pronouns

You will need a laptop or PC with a webcam, microphone, and speakers. You will need reliable internet in a private environment for both training and testing. Will you make every effort to accommodate these requirements prior to orientation?

Yes

No

Do you agree to attend the entire CPC training, Written Exam and Exit Interview as scheduled? Virtual CPC Training: February 3-17, 2025. 1pm-5pm, M-F Virtual Written Exam: To be determined (up to 2 hours) Virtual Exit Interview: To be determined (up to 30 minutes)

Yes

No

Do you consent to be recorded on Zoom for training and testing quality assurance? The recordings will never be shared with anyone except our trainers and the Health Care Authority.

Yes

No

Please note any ADA Accommodations for Training

Do you require any reasonable accommodations for training and/or exams?

Yes, I need an ADA (Americans with Disabilities Act) reasonable accommodation.

No, I do not need any accommodations.

Please choose an orientation time:

Thursday, January 30, 2025 at 1:00pm to 2:00pm

Thursday, January 30, 2025 at 5:00pm to 6:00pm

Please read and agree to this No Show/No Call statement: I agree to attend all sessions of this training in full and understand that this is a commitment. Trainers and staff at Holding the Hope put in a lot of time and funds to secure trainers and training spaces and provide food throughout each day and if I do not show up, the training may be cancelled affecting everyone else who signed up as well. I understand that if I do not call or show up for the training I signed up for, I may not be allowed to register for another training with Holding the Hope for One Year from the date of the training.

I have read the no show/no call policy and agree to the above statement. *

Yes, I agree

Do you have any questions or concerns?

VT2 – Virtual Certified Peer Counselor Training