CCS - SOAR Peer Support Specialist Referral 
A Peer Specialist is someone with their own experience of struggling with mental health and/or substance use, and, combined with formal state-sponsored training and continuing education, serves peers who are facing their own emotional challenges. Peer support is a 100% voluntary service driven by the peer's vision and priorities and focuses on the emotional connecting/sharing between two people who have their own experiences of coping with mental health/substance use challenges.

*Peer Support should not be used for or replace services/tasks such as errand-running, use of transportation, or navigting general resources not mutually included in the peer and peer supporter's experience. 

Note: "Peer" is defined as the person being referred for peer support.
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Email *
Date of Referral: *
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Is the peer enrolled in CCS? *
Referring Staff Name: *
Referring Staff Agency & Phone Number: *
Peer Preferred Method of Meeting:
Peer Identified Name and Pronouns: *
Peer Legal Name (as it appears in the CCS Module): *
Peer Address:
Peer Phone Number: *
Peer Support Focus or Need (no diagnoses need to be shared; overall need/focus is fine): *
ACCESS NEEDS
Please provide any information about your clients access needs that would be helpful for us in finding a good fit for peer support. 
Select All that Apply (checkboxes): *
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