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Peer Mentor Training Program for People with I/DD: Cohort 2 Application

Peer Mentor Training Program People with I/DD

Thank you for your interest in applying for the Peer Mentor Training Program (PMTP).

The deadline for application submission is Friday, February 25th.
More information can be found at IDDPeerMentor.com
If you have any questions, please contact the Project Director, Kelly Friedlander, at Kelly@cb-cg.com.

PLEASE NOTE: This form does not auto-save. It may be best to complete the essay questions first in a word document first, save it, and then complete the application.

First, let's make sure you qualify to participate...

Please note: This training is ONLY for individuals with I/DD. Parents and professionals interested in training opportunities should look at applying for ALP NC: https://www.alpnc.org/

1. Do you meet the Peer Mentor Training Program requirements? Reasonable accommodations will be provided.

Space Cell	Yes	No
Do you have an intellectual and/or developmental disability?	Do you have an intellectual and/or developmental disability?: Yes	Do you have an intellectual and/or developmental disability?: No
Are you 18 years or older?	Are you 18 years or older?: Yes	Are you 18 years or older?: No
Do you live in NC?	Do you live in NC?: Yes	Do you live in NC?: No
Are you familiar with community intellectual and developmental disabilities community resources (Waivers, LME-MCOs, etc.)?	Are you familiar with community intellectual and developmental disabilities community resources (Waivers, LME-MCOs, etc.)?: Yes	Are you familiar with community intellectual and developmental disabilities community resources (Waivers, LME-MCOs, etc.)?: No
Are you familiar with and able to use technology, including Zoom, Microsoft Word, and email?	Are you familiar with and able to use technology, including Zoom, Microsoft Word, and email?: Yes	Are you familiar with and able to use technology, including Zoom, Microsoft Word, and email?: No
Do you have a high school diploma, special certificate or equivalency from an approved, accredited institution?	Do you have a high school diploma, special certificate or equivalency from an approved, accredited institution?: Yes	Do you have a high school diploma, special certificate or equivalency from an approved, accredited institution?: No

Let's get your information...

2. Full Name *This question is required.

3. City *This question is required.

4. E-Mail *This question is required.

5. Phone Number *This question is required.

6. Please specify your developmental disability (or disabilities) *This question is required.

7. Education Level *This question is required.

Please enter an 'other' value for this selection.

8. Which of the following best describes you? *This question is required.

9. Do you receive services through your local LME-MCO, such as Medicaid Waiver or B3 services?

The training sessions will be held weekly on Tuesdays from 11-1 pm on the following dates:

April 5
April 12
April 19
April 26
May 3
May 10
May 17
May 24
May 31
June 7
June 14
June 21

10. Are you able to attend all training sessions?

Please enter an 'other' value for this selection.

11.

If selected to participate, you will be required to actively participate in class and complete activities outside of class. These responsibilities include:

Attend and participate in all training sessions
Complete and turn in weekly homework assignments
Complete pre and post-tests for each lesson
Complete pre and post-training evaluations

We estimate this will take approximately one hour per week outside of class time. If selected, do you commit to completing all required activities?

Finally, tell us your motivation for applying for the program...

Please note: These answers will be evaluated by a committee to see if you move on to the interview process.

12. Why do you want to participate in the Peer Mentor Training Program? *This question is required.

13. What work or life experience makes you a good candidate to be a peer mentor? Please explain. *This question is required.