• Certified Supervisor of Peer Recovery Support Specialists (Tracks 1 OR 2)

    Apply for Certified Supervisor of Peer Recovery Support Specialists (Tracks 1 OR 2). Please complete all required fields and upload all necessary documents.
  • Select Application Track*

  • Applicant Information

  • Format: (000) 000-0000.
  • Date of birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you live or work in West Virginia at least 51% of the time?*
  • Have you ever had an ethical complaint, investigation, or any action taken against a certification or license (including suspension or revocation) at any time, in any state?*

  • Track 1: Credential Prerequisite

  • Credential expiration date*
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Signature date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Track 2: Clinical Prerequisite

  • Expiration date*
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Signature date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • How do you intend to pay the application fees?*

  • STOP AND READ: DO NOT CHECK THE BOXES BELOW NEXT TO THE PAYMENT AMOUNTS IF YOU ARE NOT USING PAYPAL ON THIS FORM. DO NOT CHECK THE BOXES IF YOU HAVE OR INTEND TO PAY VIA PAYPAL ON THE WEBSITE. DO NOT CHECK THESE BOXES IF YOU ARE MAILING PAYMENT. ONCE YOU ARE REDIRECTED TO PAYPAL, IF YOU DO NOT PAY, YOUR INFORMATION WILL BE LOST AND NOT SUBMITTED.

  • Application fee pay by PayPal

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    CSPRSS Application Fee (Add On) Product Image
    CSPRSS Application Fee (Add On)
    $50.00$50.00
      
    Total
    $0.00$0.00

  • Payment Methods

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    Choose from one of the PayPal options to make your payment.

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