Purpose of This Acknowledgement

This form documents the participant’s understanding of the conditions under which the 80-Hour Medi-Cal Peer Support Specialist Training Scholarship may be withdrawn due to drop out or removal from the training cohort.

Scholarship Withdrawal Policy

1. The 80-hour Medi-Cal Peer Support Specialist Training Scholarship is cohort-specific and applies only to the approved training start date and cohort for which the participant was accepted.
2. If the participant voluntarily withdraws, drops, or is removed from the 80-hour Medi-Cal Peer Support Specialist Training cohort for any reason prior to completing the required 80-hour training:
• The 80-Hour Medi-Cal Peer Support Specialist Training Scholarship will be withdrawn, and
• The participant will no longer be eligible to utilize the scholarship or receive reimbursement for any training-related costs.
3. Any 80-Hour Medi-Cal Peer Support Specialist Training costs incurred after withdrawal, including future enrollment in a subsequent cohort, will be the sole financial responsibility of the participant.
4. Workforce program funds will not reimburse training, application, exam, or related fees for participants who withdraw from the cohort.
5. Any request for future workforce-funded training assistance, including a new 80-Hour Medi-Cal Peer Support Specialist Training scholarship, will be reviewed on a case-by-case basis.
6. Eligibility for future scholarships or training assistance is not guaranteed and will be determined at the sole discretion of program management, in accordance with local workforce policy, funding availability, and individual circumstances.

Management Review & Good Cause Clarification

Withdrawal from the 80-hour Medi-Cal Peer Support Specialist Training cohort does not automatically disqualify a participant from future workforce services. However, approval for any future 80-hour Medi-Cal Peer Support Specialist Training scholarship or training assistance will be determined case by case by program management.

Management will consider factors such as:

• Reason for withdrawal
• Attendance and participation prior to withdrawal
• Documentation of good cause (if applicable)
• Readiness to successfully complete training
• Funding availability and local policy
Any exception or approval for future funding must be documented in writing and approved by management prior to authorization.

Participant Acknowledgement

I understand that my 80-hour Medi-Cal Peer Support Specialist Training Scholarship is conditional upon active participation and completion of the assigned training cohort. I acknowledge that if I drop, withdraw, or am removed from the cohort, the scholarship will be withdrawn, and I will be financially responsible for any future 80-hour Medi-Cal Peer Support Specialist Training costs.

I understand that workforce program staff have explained this policy to me and that I have had the opportunity to ask questions.