Narcan Training

*This course is open to everyone*

What You Will Learn:
• Ability to recognize the signs of an opioid overdose,
• Demonstrate how to administer the opioid overdose reversal medication naloxone,
• Discuss the role of Harm Reduction in the opioid public health crisis, solutions, action plan, and strategy,
• Attendees will receive free Narcan

For more information about Trainings and cost please contact dsmith@newlife2.org

Apply for Narcan Training:

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For Which Training Course Are You Applying?*

Co-Supervision: Supporting the Peer Workforce

Integrated Healing Facilitator (Friends & Family)

Certified Peer Support & Recovery Professional

Narcan Training

Understanding Peer Support

Intentional Peer Support

Date*

Day

Month

Year

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone

Best Time to Call*

Hours

Minutes

AM/PM

Eligiblity Requirements

Required If you are applying for Certified Peer Support & Recovery Professional Training

The State of Connecticut requires applicants to have personally experienced mental health treatment and/or psychiatric hospitalization that has meaningfully affected their lives and relationships over an extended period.Does this apply to you?*

Yes

Please provide a detailed explanation of your experience:*

Have you encountered challenges related to substance use, addiction, or participated in treatment or recovery programs addressing these issues?*

Yes

Please describe your experience with substance use and recovery, including how it has shaped your personal journey:*

This position asks that you utilize your personal recovery experience, including substance use and mental health, as a foundation for supporting others. Are you willing to openly share and apply your lived experience in this role?*

Yes

Reflective Questions

Please answer each prompt in approximately 3 to 5 sentences. There are no right or wrong answers. Your responses help us better understand your readiness and perspective.

1. What motivates you to become a Certified Peer Support & Recovery Professional (CPSRP), particularly in the areas of addiction and mental health recovery?*

2. How do your lived experiences with substance use and/or mental health conditions uniquely prepare you to provide support to others?*

3. Beyond traditional clinical interventions, what additional supports or personal practices have been important to your recovery process? (For example, peer groups, faith-based initiatives, holistic approaches, or community activities.) :*

4. From your perspective, what improvements or changes would you advocate for within mental health and addiction support systems to better serve individuals in recovery?*

5. How have your personal recovery experiences influenced your ability to engage effectively with people from a variety of cultural, social, and economic backgrounds?*

Demographic Details

Providing this information helps us understand and serve diverse communities more effectively. It will not influence your application outcome.

1. Age Category:*

Under 18

18-24

25-34

35-44

45-54

55-64

65 or older

Prefer not to respond

2. How do you identify your gender? (Select all that apply):*

Female

Male

Nonbinary

Transgender

Prefer to Self Describe

Prefer not to Respond

Your Answer:

3. Which racial or ethnic group(s) do you identify with? (Select all that apply):*

Black or African American

Hispanic, Latino/a/x

White or Caucasian

Asian or Asian American

Indigenous (Native American, Alaska Native)

Middle Eastern or North African

Pacific Islander or Native Hawaiian

Multiracial or Mixed Background

Other:

Prefer Not to Respond

Your Answer

4. Do you identify as an individual with a disability?*

Yes

Prefer not to respond

5. Do you speak languages other than English?*

Yes

Prefer not to respond

Please List:

Education and Relevant Experience

Please share information that highlights your background. We value all types of learning and experience, including formal education, volunteer work, caregiving, community involvement, and personal recovery.

1. Highest education level completed:*

High school diploma or equivalent (GED)

Some college coursework completed

Associate’s degree

Bachelor’s degree

Graduate or professional degree

Vocational or trade certification

Other

Prefer not to respond

Please describe:

2. Are you currently participating in any educational, certification, or training programs?*

Yes

Please describe

Work and Volunteer Experience

List any professional or volunteer roles you have had that relate to peer support, addiction recovery, advocacy, community outreach, caregiving, or other relevant areas.

1. Organization or Employer:

2. Role or Title:

3. Dates of Service:

4. Summary of Responsibilities:

Is there additional information about your work or education experiences, especially those connected to substance use recovery or peer support, that you would like to share?

Acknowledgement and Signature

Please review the following statement and sign below:

I affirm that the information I have provided in this application is accurate and complete to the best of my knowledge. I understand that this information is necessary to assess my eligibility and preparedness for participation in the Integrated Healing Facilitator (RSS) program. I recognize that falsifying information may result in disqualification or removal from the program. I also understand that my personal information will be treated confidentially and handled according to privacy regulations, except where disclosure is required by law. I consent to the review of my application by authorized personnel involved in the selection and training process.*

I agree

Signature*

Date:*

Printed Name:*

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