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Supplemental Questionnaire

Last Name
First Name


***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.***


Are you certified as a Peer Recovery Specialist with the Maryland Addiction and Behavioral Health Professionals Certification Board?  If not, what requirements do you still need to meet to become certified?


Have you received any other training or certification?

Yes No

What experience do you have with peer recovery support services? Including in your response, dates and places of employment. This information must also be reflected in your application. If you do not have this experience, enter N/A

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