Peer Training Academy Application

MHA Rochester Peer Training Academy Online Application

Legal Name (First & Last):(Required)
Preferred Name (First & Last):
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Entitlements - please select all that apply:
Living Situation - please select all that apply:(Required)
If you answered Yes, please select the other Mental Health Association programs you participate in:
The Mental Health Association Peer Training Academy welcomes a diverse student roster with co-experiences - people with a mental health diagnosis who also have other lived experiences, such as military veterans, LGBTQIA+, incarceration, homelessness and/or substance use. This diversity of experience reflects the needs and perspective of mental health service users - the very people MHA graduates will be supporting in their work. It's important to us as a peer program that our classroom reflect the people we support. - Please answer the following questions as accurately and thoroughly as you can.(Required)
ACCES-VR Information (formerly VESID)
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.