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The Peer Network
www.ThePeerNetwork.org
1-833-PEERNET

The Peer Network (TPN) Subscription Application

Mission

Ensuring quality mental health and wellness peer resources by growing sustainable mental health peer-run organizations.

Vision

A mentally healthy world!

Mental Health Peer-Run Organizations are:

Autonomous
Peer-governed
Peer Run
Peer Support
Evidence based as per Substance Abuse Mental Health Services Administration (SAMHSA)

Peer-Run organizations serve a unique and valuable role in mental health recovery services.

Name of Organization

Street Address *

City *

State *

Zip Code *

Organization Phone Number *

Email *

Website *

Contact Person

First Name *

Last Name *

Title *

Phone Number *

Email Address *

Are you designated 501c3? *

Yes

No

If yes, what is your Tax Exempt Number? *

Counties Served

What is your interest in mental health peer support services? *

What is your interest in peer run organizations? *

Describe what stage your organization is in? Have you created the organization? Are you a start-up? Are you a fairly new organization? Or are you fairly established? *

Business Needs

Please check all

services you

feel you need

assistance with

Services

Check all Peer Serivces

you offer at your

organization

Other

Agreement

By checking this box, the organization on this application fully agrees or assents to the processes, policies, and procedures of The Peer Network and hereby agrees to abide by all Rules and Regulations of The Peer Network. Once found eligible by The Peer Network, will submit payment for subscription to the services and programs provided by The Peer Network. *

I agree

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to
subscription acceptance, I understand that false or misleading information may result in the organizations release.

Signature *

clear

The Peer Network www.ThePeerNetwork.org 1-833-PEERNET

The Peer Network (TPN) Subscription Application

The Peer Network
www.ThePeerNetwork.org
1-833-PEERNET