Rochester NY - Youth Peer Advocate or HYPE Ambassador training interest and screening form 

1. A Youth Peer Advocate is an individual between 18-30 years of age who has self-identified as a person who has first-hand experience with emotional (mental health), behavioral challenges, and/or co-occurring disorders as a young person or has received services in any one of the child-serving systems (juvenile justice, special education, substance use disorder, or foster care). YPAs use their lived experience to assist in supporting youth in their resiliency/recovery and wellness.  We also will accept Youth ages 17 for our YPA cohort. 

2. Healing -Centered Youth Peer Education (HYPE) Ambassador is a school age youth ages 12-16 who have the desire to support other peers and help their community during stressful situations and traumatic environmental experiences.      

This confidential form will help us screen individuals interested in participating in the six-week or two-week training cohort and understand your needs. Once this form is complete, you will be invited to a zoom information session.   The orientation will be on April 30th in person at 4:30pm for all who have completed the information session. 


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Email *
Youth Collaborative
The purpose of this Mental Health Peer and Workforce Development project is to offer Youth who have experienced system involvement or traumatic, mental/behavioral, environmental, stressors, training to develop skills and strategies. These individuals will in turn use their skills and lived experience, to empower and support other Youth who may be experiencing system involvement or traumatic life impacting events in their lives.
First and Last Name  *
Phone Number  *
Zip Code  *

Using the Youth Peer Advocate and HYPE Ambassador definitions at the top of the page, which of the two categories below do you self-identify with?

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Do you self-identify as an individual who has first-hand experience with emotional (mental health), behavioral challenges, and/or co-occurring disorders?

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Have you received services or had challenges in any one of the child-serving systems (juvenile justice, special education, substance use disorder, or foster care)? If so, which? *
What does mental health (wellness) mean to you? *
How do you handle difficult conversation or conflict? *
Do you self-identify as a being part of the BIPOC (Black Indigenous, People of Color). Including Latin X, Asian, Refugee community? 
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What are you hoping to gain from participating in this training program?
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In the case that weather forces classes to be held virtually. Do you have regular access to a computer and the internet, on a weekly basis in your home?  Check all that apply. 

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Required
The Youth Peer Credentialing requires a minimum of a high school diploma or GED.  In some case there are exceptions. Please check which applies to you: *
Required

What primary language do you speak and write? 

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Do you have any accommodation needs (learning or limited mobility and cannot use stairs? 

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If I am accepted to participate in the cohort, I am expected to participate fully, in the four- six-week in person and online sessions.   I understand there will be an in-person orientation session on April 30th at 4:30pm. *
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