Scholarship Award Details

This form confirms that the participant named above has been approved for workforce-funded financial assistance to support participation in the 80-hour Medi-Cal Peer Support Specialist Training.

Training Scholarship

• Total Training Cost: $2,500
• Scholarship Amount Awarded: $2,500
• Participant Financial Responsibility: $0

The $2,500 training cost includes required Training-related fees, specifically:

• $100 CalMHSA Application Fee Voucher, and
  • Covers required CalMHSA application fee
  • Issued in accordance with supportive service policy
• $150 State Certification Exam Fee Voucher (first exam attempt only).
• Covers required Medi-Cal Peer Support Specialist Certification exam fee
• Exam outcomes are determined by the certifying authority

The Peer Workforce Development Program will only cover the cost of the first State Certification Exam attempt. If the participant does not pass the exam on the first attempt, any additional exam fees, retakes, or related costs are the sole responsibility of the participant. No reimbursement or additional vouchers will be issued for subsequent exam attempts. In addition, if the participant pays for the exam or application fee themselves, or if an employer chooses to pay these costs, the associated vouchers will be forfeited, and no reimbursement will be provided.

These financial supports are provided as part of the participant’s workforce service strategy and are intended solely to enable participation in approved training and credential attainment activities.

Training Commitment

By accepting this scholarship, the participant acknowledges and agrees to the following:

• I understand that this scholarship is awarded specifically for participation and completion in the 80-hour Medi-Cal Peer Support Specialist Training program.
• I agree to attend and complete the full 80-hour Medi-Cal Peer Support Specialist training.
• I understand that failure to attend, withdraw, or complete the training without good cause may result in repayment obligations or impact future eligibility for workforce services, in accordance with the Leave of Absence section in the Policies and Procedures.
• I agree to comply with all training provider requirements, attendance policies, and professional conduct expectations.

Certification Requirement Acknowledgement

I understand that completion of the 80-hour Medi-Cal Peer Support Specialist training does not guarantee certification. Certification requires:

• Successful completion of the 80-hour Medi-Cal Peer Support Specialist training, and
• Sitting for and passing the State Medi-Cal Peer Support Specialist Certification exam.

I understand that exam outcomes are determined by the certifying authority and not by the training provider.

Information Release & Documentation

I authorize the training provider and Peer Workforce Development Program staff to:

• Verify my enrollment, attendance, and completion status
• Receive documentation related to training completion and certification
• Use this information solely for workforce program documentation, performance reporting, and compliance purposes

Participant Certification and Acceptance

I certify that the information provided above is accurate. I understand the terms and conditions of this scholarship and voluntarily accept the 80 hour Medi-Cal Peer Support Specialist Training Scholarship as outlined in this form. I also acknowledge my commitment to fully participating in and completing the 80 hour Medi Cal Peer Support Specialist Training program.