certified recovery peer advocate provisional (crpa p ...€¦ · 5/4/2020 · (crpa-p) application...

Certified Recovery Peer Advocate-Provisional (CRPA-P) Application Form

ASAP-New York Certification Board | 5-2020 [email protected]

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Certified Recovery Peer Advocate-Provisional (CRPA-P)

Application Form

Please PRINT clearly or type

Candidate’s Signature _____________________________________________________ Date _______________________________

NYCB Fee Policy: By signing below, I acknowledge the current fee associated with the CRPA-P certification (listed

above) and understand that all fees are non-refundable and may change at any time. For a complete list of NYCB fees,

please visit the NYCB website (http://www.asapnys.org/ny-certification-board/).

I understand that I am responsible for all fees associated with the certification process at the time of my initial application

and that my application will not be processed until payment is received.

All fees must be paid by check, money order, or credit card. No cash payments will be accepted. A fee of $35 will be

due for all returned checks and a hold will be placed on my application until the original and returned check fees are

received by the NYCB. To pay by credit card, please use our online payment portal at https://

events.r20.constantcontact.com/register/eventReg?oeidk=a07egzrna44e90cbb28&oseq=&c=&ch=.

* Please note that all incomplete applications and fees paid expire one year after receipt.

CRPA-P Fee (All NYCB Fees are Non-Refundable)

CRPA-P Application Filing Fee * $100.00

Legal name as found on driver’s license or legal ID:

First: M.I. Last:

Home Street Address:

City: ST: Zip:

Email:

Cell phone #: Home phone #:

CRPA-Provisional and CRPA candidates must be at least 18 years old Date of Birth:

I graduated from High School (circle one) Date _________________________

Yes No

You must submit a copy of one of the following:

High school diploma or transcript showing date of graduation

Accredited high school equivalency diploma or certificate

Transcript or diploma from accredited institution of higher education

http://www.asapnys.org/ny-certification-board

https://events.r20.constantcontact.com/register/eventReg?oeidk=a07egzrna44e90cbb28&oseq=&c=&ch=




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As you work toward full CRPA certification, please note that work and supervision which occurred in a treatment setting while you were actively in treatment in that setting will not meet the requirements.

I have read the above CRPA-Provisional requirements and I understand that I MUST MEET ALL CURRENT REQUIREMENTS in order to be eligible to become certified as a CRPA-Provisional.

Candidate’s Signature _________________________________________________ Date ___________________________

Requirements for Certification

Certified Recovery Peer Advocate-Provisional

Education

Candidate must provide a copy of one of the following:

• High school diploma or transcript showing date of graduation OR

• Accredited high school equivalency diploma or certificate OR

• Transcript or diploma from accredited institution of higher education

Peer Recovery Training

Candidates must submit copies of training certificates confirming successful

completion of 46 hours of NYCB-approved training which includes the equivalent of:

• 10 hours Advocacy

• 10 hours Mentoring/Education

• 10 hours Recovery/Wellness Support

• 16 hours Ethical Responsibility in the Peer Recovery role

Role Experience:

CRPA-Provisional

In March 2020 the New York Certification Board removed the requirement that a

candidate must currently be working in a peer recovery role (paid or volunteer)

under appropriate supervision/management. No work experience is currently

required.

NYCB Code of Ethical Conduct

Candidate must agree to read and abide by the NYCB Code of Ethical Conduct. This

handbook may be downloaded at our website: http://www.asapnys.org/ny-

certification-board/. Candidate must endorse and sign the NYCB Code of Ethical

Conduct statement (page 4).

Application Expiration If any application remains incomplete and on hold for one year or more, all fees paid will expire.

Annual Renewal Requirement The CRPA-P certification is non-renewable and expires 24 months after effective

date.

UPGRADE REQUIREMENT

CRPA-Provisional is issued for only 24 months.

You must upgrade and pass the exam within 24 months

to remain certified.

CRPA-Provisional certification is non-renewable.

Candidate must complete all CRPA requirements and submit an Upgrade to CRPA

application along with the $50 upgrade and $80 exam fees ($130) at least 45 days

prior to expiration of their CRPA-Provisional certification date (24 months):

500 hours of peer recovery work experience (paid or volunteer) which includes

25 hours of supervision (confirmed by appropriate supervisor).

Candidate may take the exam anytime during the two-year certification period

as long as the exam fee has been paid. NYCB staff must first pre-register eligible

candidates in order for candidate to pick date and place of exam.

Pass the computer-based IC&RC Peer Recovery Exam.

Upgrade to CRPA application must be approved by the NYCB.





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Your Checklist for the

CRPA-Provisional Application

Please make sure you complete all of the following items in order to ensure timely

processing of your application.

Check off each item as it is completed. Your application will not be processed until you

submit the filing fees and all of the following items have been received:

Candidate’s Signature _________________________________________________ Date ___________________________

I have completed all of the above items and have submitted them according to the NYCB submission

instructions and current CRPA-Provisional requirements.

Pay the application filing fee of $100.00. You may pay by check or money order (payable to NYCB). You

may also pay by credit card for all payments required for CRPA-P certification using the NYCB Peer Certification Payment Portal at https://events.r20.constantcontact.com/register/eventReg?

oeidk=a07egzrna44e90cbb28&oseq=&c=&ch=. You can only select one option for payment. If you

don't see a choice relevant for you, please email [email protected].

Review your entire CRPA-P Application. Fill out, sign, date, and initial where asked. Electronic signatures

and initials will be accepted. Submit only numbered pages 1-5.

Include a copy of your high school diploma OR a high school transcript showing date of graduation OR accredited equivalency OR transcript or diploma from accredited institution of higher education. If your

name has changed since this document was issued, provide a copy of a legal document clearly showing

the change from one name to another (such as a marriage license or divorce decree).

Include copies of training certificates confirming successful completion of 46 hours of NYCB-approved

training. This training includes the equivalent of: Peer Advocacy (10 hours), Peer Mentoring/Education

(10 hours), Peer Recovery/Wellness Support (10 hours), and Ethical Responsibility for Peers (16 hours).

Download a copy of the NYCB Code of Ethical Conduct from our website. Read it before you sign and date the NYCB Code of Ethical Conduct statement on page 4. Certificants are required to abide by the

provisions of the code or face censure by NYCB.

Read, sign, and date the Authorization to Obtain Information Statement on page 4.

Read and initial each box, then sign and date the CRPA-Provisional Attestation form on page 5.

Make a copy of the entire packet for your records prior to submitting to NYCB.

Familiarize yourself with the four steps toward certification found on page 6.

Submit your application only when you have filled out, signed, dated, and initialed each page

as requested.

Incomplete applications will be delayed.



mailto:[email protected]



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NYCB Code of Ethical Conduct Statement

A. I hereby attest that all of the information given is true and complete to the best of my knowledge and belief. I

understand that falsification of any portion of this application will result in my being denied certification or revocation of same, upon discovery.

B. I acknowledge the right of the NYCB to verify the information in this application or to seek further information from employers, schools, or persons mentioned within.

C. I have read, understand, and agree to act in accordance with the NYCB Code of Ethical Conduct (2012) and the NYCB Code

of Ethical Conduct - Disciplinary Procedures (2012) available on the NYCB’s website at http://www.asapnys.org/ny-

certification-board/.

D. I will hold NYCB, Inc., its Board members, officers, agents, and staff free from any civil liability for damages or complaints by reason of any action that is within their scope and arising out of the performance of their duties which they, or any of them, may take in connection with any examination, and/or failure of the Board to bestow upon me certification with the NYCB or any other entity.

E. I understand that upon acceptance of my application, additional fees may be due and payable including exam fees,

renewal fees, etc. and that all NYCB fees are non-refundable without exception.

By signing in this box, I agree to all aspects of the statement above.

Candidate’s Name (print): Date: __________________

Candidate’s Signature:___________________________________________________________________________________

Authorization to Obtain Information Statement

I hereby authorize the NYCB to request and receive all records and/or information in any way relating to my application for a NYCB credential. I understand that this includes, but is not limited to, verbal or written contacts with my employer(s), colleagues, academic and training institutions, and/or other persons or organizations having pertinent information related to the review of my application. This is a waiver of my privilege that may otherwise exist in respect to the disclosure of such information. I understand that this authorization will expire one year after certification lapses or when my certification expires, once NYCB is notified of my intent not to renew. I further understand that the status of any NYCB credential is public record and may be shared by NYCB and is available on the NYCB website, including effective date, expiration date and certification type. I further understand that if my NYCB credential is sanctioned in any way including revocation or suspension that this information is public.

By signing in this box, I agree to all aspects of the statement above.

Candidate’s Name (print): Date: __________________

Candidate’s Signature: ___________________________________________

Disclaimer

Personal information in this application is considered confidential and may only be disclosed with written consent, a court-ordered subpoena, or conditions specified in New York State law with respect to the protection of persons with special needs. The sole exception to this policy permits ASAP-NYCB to release applicant contact information (i.e., telephone numbers, email addresses, work or home addresses) to Federal or State authorities in the event of a national or regional disaster/emergency, unless the applicant indicates below that he/she does not want personal contact information released.

Check here if you would prefer not to have your personal contact information released in the event of a regional of national emergency. Certification award is not contingent on providing permission to share this information.

http://www.asapnys.org/ny-certification-board/




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Effective June 1, 2016, the Certified Recovery Peer Advocate-Provisional (CRPA-P) certifica-

tion was introduced for candidates interested in completing all of the requirements for the

Certified Recovery Peer Advocate (CRPA) certification but did not have all the required work

experience. The CRPA-Provisional is issued for 24 months without renewal to eligible candi-

dates who :

Meet minimum requirements for age, education, training;

Agree to abide by the NYCB Code of Ethical Conduct statement; and

Affirm their willingness to complete all remaining CRPA requirements prior to the

expiration of their CRPA-Provisional certification.

Candidates must attest to the following prior to the CRPA-P certification being issued

Certified Recovery Peer Advocate-Provisional (CRPA-P)

Certification Attestation

B y i n i t i a l i n g e a c h b o x a b o v e a n d s i g n i n g b e l o w , I a g r e e t o c o m p l y w i t h a l l

a s p e c t s o f t h e C R P A - P r o v i s i o n a l C e r t i f i c a t i o n A t t e s t a t i o n s t a t e d a b o v e .

Candidate’s Signature _____________________________________________________ Date _______________________________

CATEGORY REQUIREMENT

Please initial

each box

below

Code of Ethical Conduct I have read and agree to abide by the NYCB Code of Ethical Conduct and

Disciplinary Procedures.

Upgrade to CRPA Application

I will complete and submit the Upgrade to CRPA application within 45

days before my CRPA-Provisional certification date expires. Failure to do

so may cause a lapse in certification.

Peer Recovery Experience I will complete no less than 500 hours of peer recovery experience prior

to submission of my Upgrade to CRPA application.

Peer Recovery Supervision

I will complete no less than 25 hours of peer recovery supervision with a

qualified supervisor prior to submission of my Upgrade to CRPA

application.

Peer Recovery Exam

I will pass the IC&RC Peer Recovery Computer-Based Exam within 24

months of CRPA-Provisional certification. For details, please see website:

http://www.asapnys.org/ny-certification-board/crpa-upgrade/.

Certification acronym

I will indicate the Provisional status of my CRPA-P certification at all times

by writing out the full acronym CRPA-Provisional on clinical records,

business cards, and correspondence.

http://www.asapnys.org/ny-certification-board/crpa-upgrade/



About the Certified Recovery Peer Advocate-Provisional Certification

The New York Certification Board defines a Certified Recovery Peer Advocate (CRPA) as a person who provides outreach, advocacy,

mentoring, and recovery support services to those seeking or sustaining recovery. For the purpose of certification, a Certified

Recovery Peer Advocate is defined as a professional who has demonstrated competence in performing a range of activities as

defined by the IC&RC Peer Recovery Job Task Analysis (2013) and the IC&RC Peer Recovery Candidate Guide (2015) (https://

internationalcredentialing.org/)

In order to become certified as a CRPA, a candidate must demonstrate they have completed appropriate education, training,

and work experience (paid or volunteer) and meet the CRPA standards. Please review current details posted on the NYCB

website - http://www.asapnys.org/ny-certification-board/nycb-certifications/.

In all activities, the certified professional must demonstrate consistent adherence to the NYCB Code of Ethical Conduct (2012) &

NYCB Code of Ethical Conduct - Disciplinary Procedures (2012) and agree to continue their professional development with

ongoing education and training specifically related to peer recovery.

Effective June 1, 2016, the Certified Recovery Peer Advocate-Provisional (CRPA-P) certification was introduced to help

candidates who are interested in completing all of the requirements for the Certified Recovery Peer Advocate (CRPA)

certification, but do not have the required number of hours working or volunteering in a peer recovery advocate role.

The CRPA-Provisional certification is issued for 24 months without renewal to eligible candidates who meet minimum

requirements for age, education, and training, agree to the NYCB Code of Ethical Conduct, and affirm their willingness to

complete all remaining CRPA requirements prior to the expiration of their CRPA-Provisional certification. These requirements

include:

Accrue 500 hours of peer recovery work experience (paid or volunteer) including 25 hours of supervision specific to the

peer recovery domains.

Submit a completed Upgrade to CRPA application 45 days prior to expiration date so there is no lapse in certification and

receive New York Certification Board approval.

Pass the IC&RC Peer Recovery computer-based exam.

CRPA-Provisional

is issued and is

active for 24

months from the

first day of the

following month.

Step 1

Fill out and submit a

completed application

Include all required

documents

Pay filing fee

Step 2

NYCB Staff will review application and notify if anything is missing

Step 3

NYCB Certification

Director will confirm eligible candidates

Step 4

The NYCB Board will

approve eligible candidates

NYCB Staff will email

certification

Once you have submitted your application materials… You will receive written confirmation your packet has been received.

After your application has been reviewed, we will notify you in writing (via email) about the status of your application within

approximately 4-6 weeks of receipt. If changes or additional information are required, you will be notified in writing at that

time.

We will notify you, by email, when your application has been approved by the New York Certification Board.

If you have questions about your certification packet after submitting it to us for review, or if you have not received an

electronic notification within 4-6 weeks, please email [email protected] for assistance. We will respond to your inquiry as

soon as possible.

Please do not call the NYCB office to inquire about the status of your application.

If you have questions about the certification process, please email [email protected] for assistance.

As you work toward full CRPA certification, note that work and supervision which occurred in a treatment setting

while you were actively in treatment in that setting will NOT meet the requirements.

New York Certification Board A Project of

Alcoholism & Substance Abuse Providers of New York State

11 N Pearl St, Suite 801, Albany, NY 12207-2850

Phone: 518-426-3122 x 101 Fax: 518-426-1046

[email protected] | www.asapnys.org/ny-certification-board/

https://internationalcredentialing.org/

https://internationalcredentialing.org/

http://www.asapnys.org/ny-certification-board/nycb-certifications/





certified recovery peer advocate provisional (crpa p ...€¦ · 5/4/2020 · (crpa-p) application...

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