CPS Proctor Agreement Form – Missouri Peer Specialist

CPS Proctor Agreement

"*" indicates required fields

Thank you for agreeing to become a Missouri Credentialing Board Certified Peer Specialist Proctor! You do not have to be a technical expert, nor do you have to hold a Certified Peer Specialist (CPS) Certification to be a proctor. However, the Missouri Credentialing Board does require that a proctor have a “professional” working relationship with the applicant: Supervisor, sponsor, minister, etc. Please note that becoming a proctor is a big responsibility. You are responsible for protecting and maintaining the integrity of the CPS Certification process. As an approved proctor for CPS certification exams, you are part of a network of individuals who support professional excellence in the field of peer certification. As a proctor it is your responsibility to:

Log on to the online test for the applicant. (Log on instructions will be emailed to you once the applicant completes the CPS training);
Ensure the candidate is accessing the correct exam.
Be present during the exam.
Assist the applicant with either the retest process or printing the CPS test certificate upon passing the exam. (Please note that not everyone passes the exam on the first attempt. You may have to assist the applicant with multiple test attempts).

Applicant's Name*

First Last

Dates the Participant Took or Is Taking CPS Training*

CPS Proctor Information

Please take a few minutes to fill out the application questions listed below.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone*

Relationship to CPS Applicant*

In your opinion is the applicant ready to provide peer services?*

Yes

Please provide a brief explanation of your answer*

Are you planning on hiring the Peer Applicant?*

Yes

If no, please explain.*

Please provide a brief description of the CPS applicant and why you feel they would be a good certified peer specialist.*

Signature

By signing this form you agree to proctor the CPS Exam for the above listed applicant.

CPS Proctor Agreement

CPS Proctor Information

MoPeerSpecialist.Org