PRSS-SUD Recertification Application

West Virginia Certification Board for
Addiction and Prevention Professionals
436 12th Street Suite C, Dunbar, WV 25064
Phone 304-768-2942
Email: wvcbapp@wvcbapp.org

Two-Year Recertification Instructions

After the initial certification period, renewal of the PRSS is required every two years. During each two-year cycle, recertification will require 20 contact hours of WVCBAPP approved education which needs to be in the following domains:
- Advocacy
- Mentoring/Education
- Recovery/Wellness Support
- Ethics (of the 20 hours needed for renewal, 6 hours must be in IC&RC Peer Recovery (PR) Code of Ethics)
If you have all of the necessary continuing education hours but miss the deadline for submission of your application for recertification, you have a 90-day grace period within which you may submit your application with a $75 late fee.

You have a 90-day grace period to get the required materials to us with the late fee; however, education hours may not be acquired during this period. Should the grace period expire, a new initial application must be submitted and the exam will have to be retaken.

After the recertification date expires, the individual will no longer hold a PRSS and no further use of the PRSS is permitted until the individual has recertified.

An Applicant for a two-year recertification should submit the following documents and fees:
1. Completed PRSS-SUD Recertification Form
2. Application Signed Code of Ethics Statement
3. Signed Statement of Personal Recovery
4. Documentation of 20 contact hours of WVCBAPP approved education in the different domains mentioned above which must include six (6) hours in IC&RC Peer recovery (PR) Code of Ethics for the two-year recertification cycle.
5. $100 renewal fee if received by 8/30 of the year of recertification. Enclose an additional $75 late fee is if application is sent after 8/30 of the year of recertifcation.*
*All fees are non-refundable. Checks or money orders should be made payable to: WVCBAPP and mailed to 436 12th St. Suite C, Dunbar, WV 25064.

Online payments are accepted at www.wvcbapp.org/purchase using PayPal or by submitting with this form.

*Additional information about initial applications or recertification can be located in the credential's manual available online at: www.wvcbapp.org/applications
PRSS-SUD Recertification Application

West Virginia Certification Board for Addiction and Prevention Professionals
Before You Begin the Application

Ensure that all required documents are completed and available in one of the following formats: PDF, DOC, DOCX, XLS, XLSX, CSV, TXT, RTF, HTML, ZIP, MP3, WMA, MPG, FLV, AVI, JPG, JPEG, PNG, GIF.
Date*

MonthDayYear
Date
Has any of the information below changed?*

Yes, I have updated the demographics form on the websiteNoYes, I have not completed the demographics form on the website and understand this form cannot be processed until that is complete.
What information has changed?
Name*

First Name викторовнаLast Name
Maiden, Nickname, or Preferred Name:
Optional
E-mail*
example@example.com
Phone Number*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Highest Education Level*
Certification Currently Held (select all that apply)*

PRSS-SUDPRSS-MHAADCADCPSI or PS2CCJPCSCSPRSSCSPRSS-CLOther
License Currently Held: (select all that apply)*

LPCLICSWBSWLSWMD/DOMFTRNLPNNot applicableOther
PRSS-SUD Certification Number:*
First Year of Employment in the Field*
Current Employment:
Current Employer*
Name of Current Employer or NONE if not Employed
Position*
Statement of Personal Recovery – The PRSS-SUD requires at least 2 years (24 months) of sustained recovery. Self-reports will be taken into consideration on a case by case basis.

I, the undersigned individual, affirm that I have successfully pursued my own personal health recovery experience involving the use of alcohol and/or other drugs.

I affirm that I have not used any alcohol or other drug affecting my central nervous
system, or other drug causing physical or psychological dependence, to which I was addicted or upon which I was previously dependent, within the past two years.

I further affirm that I have not used controlled substances which were
obtained illegally or misused any controlled substances which were obtained with a valid prescription order from a licensed health care provider, within the past 2 years.

I affirm that in the event I experience a relapse in my recovery or experience other psychological or physical health conditions which may interfere with and impair my PRSS functioning, I will seek appropriate therapeutic care, request a
voluntary inactive status from WVCBAPP, and I will not provide services as a Peer Recovery Support Specialist.

I affirm that I have maintained and will continue to maintain a minimum of one (1) hour a week of clinical supervision sessions per month by an organization’s qualified supervisory staff while I am providing services in the PRSS capacity.
Are you currently directly working as a PRSS with clients?

Yes, I have met the 1 hour per week supervision requirements.Yes, and I HAVE NOT met the 1 hour per week supervision requirement.No, I am not working directly with clients in the PRSS role.
My present period of continued recovery from alcohol or other psychoactive drugs is Years* and months* .
Do you have any former, ongoing or outstanding ethical complaints including self-reported use?

YesNo
If less than 24 months of continued recovery from alcohol or other psychoactive drugs, was the reoccurrence of symptoms reported to WVCBAPP as required?
Signature*

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Date*

MonthDayYear
Date
Ethical Code of Conduct Peer Recovery

It is the policy of the West Virginia Certification Board for Addiction Professionals to promote and safeguard the quality, effectiveness and competence of Peer Recovery through the insistence of adherence to its Code of Ethics by all WVCBAPP certified Peer Recovery specialists.

The ethics committee develops and recommends an ethical code of conduct for adoption by the Board of Directors. Currently, the Board has adopted the code of conduct adhered to by IC & RC located at
https://www.wvcbapp.org/ethics.

The ethics committee has jurisdiction over all matters of violation and misconduct by WVCBAPP certified peer recovery specialists in the state of West Virginia. It immediately and thoroughly investigates such charges and makes recommendations to the Board of Directors for appropriate action.

I hereby attest that I have read, understand, and will adhere to the IC&RC Peer Recovery Code of Ethics and including, a subsequent change to the code of ethics that is duly approved by the IC&RC Board of Directors at a regularly scheduled Board Meeting.

It is my responsibility to remain current and comply with the code of ethics for this and other credentials awarded by my credentialing body throughout the life of the credential.
Ethical Code of Conduct*

I agreeI disagree
I am requesting grant funding for my recertification fee. I understand the grant DOES NOT cover the late/rush processing fee applied after 8/30. This does not delay the review process.

Accept grant fundingDecline grant funding making payment to WVCBAPP
How will you be paying the fee?*
The grant has expired.
Pay Fees via PayPal-DO NOT check these boxes if you are not paying with Paypal
prevnext( X )
PRSS-SUD Recertification FeeRecertification fee can be paid here, on our website, or via mail. All payments made via PayPal are charged an 8% processing fee.
$108.00

Late/Rush Processing FeeInclude after 8/30 of your recertification year. This can also be paid on our website or via mail. All payments made via PayPal are charged an 8% processing fee.
$81.00

Total

$0.00
If PayPal was used, what agency or name is on the account?:
Upload Certificates for 20 hours of CEUs including 6 hours of ethics. *

Cancelof
Signature*

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Date*

MonthDayYear
Date
Your participation in an optional survey helps to obtain funding for certification located at

Peer Recovery Support Specialist Survey: https://www.surveymonkey.com/r/WVCBAPP-PRSS

Please don't forget to return to submit your application. You should see a thank you page once your application has been submitted.
Should be Empty:

PRSS-SUD Recertification Application

Current Employment: