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WestCoast Children's Clinic: Medi-Cal Peer Support Specialist Certification Training Interest Form

Thank you for your interest in participating in our peer training program! The information you provide will help us identify training dates and times based on the availability of participants interested in our cohort. While we strive to accommodate as many schedules as possible, please note that due to various constraints, we may not be able to accommodate every individual schedule. We will do our best to find a solution that works for the majority of participants.

Once a training schedule is identified, we will email you with details for the upcoming cohort, including a link to the application and dates and times for information sessions.

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Name (First and Last) *
Email address *
Phone number *
Do you currently work in Alameda County? *
What days of the week are you typically available for training? Check all that apply *
Required
What times of day are you generally available? Check all that apply *
Required
How soon are you looking to begin training? *
What is your primary reason for wanting to participate in the peer training program? *
Would you like to be added to our email list to receive updates about future trainings, scholarships, or other peer-related information? *
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