Documents and Forms

The following forms are available in MS Word and Adobe PDF (version 5.0) formats.  If you do not have Adobe Acrobat, you may download a copy from the Adobe Website. Click on the title below for the certification/program you want to expand that section.

MHRT/Community Guidelines

MHRT Guidelines (As of 6/30/20)


MHRT/Community Application Form (Appendix D)

Application (Appendix D) Word Application (Appendix D) PDF


MHRT/Community Knowledge Competencies

MHRT-C Knowledge Competencies


MHRT/C Renewal Form

Renewal Form Word Renewal Form PDF


MHRT/Community Credit for Work Experience (Waiver) Forms (Appendix G)

Domain 2: Community Integration and Inclusion (only available to individuals with a qualifying degree)

Domain 2 PDF


Domain 4: Trauma and Resiliency

Domain 4 PDF


Domain 5: Policy Knowledge

Domain 5 PDF


          Domain 6: Mind-Body Connection

Domain6 PDF


Domain 7: Cultural Competency

Domain 7 PDF


Domain 8: Vocational Support

Domain 8 PDF


If you are completing 2008 requirements and need a Credit for Work Experience Form for one of the 2008 courses, please contact us


MHRT Work Experience Verification Form

Required for those who have not completed a relevant program or degree.

 Work Experience Verification Word   Work Experience Verification PDF

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Provisional Mental Health Rehabilitation Technician I (Provo-MHRT I) Handbook 2006

Provo Handbook Word    Provo Handbook PDF


Provisional MHRT I Certificate from the back of the Provisional Mental Health Support Specialist (MHSS) 
UPDATED June 2014

Provo MHRT I Cert Word    Provo MHRT I Cert PDF


Simple Steps to MHRT I Certification, April 2018

Not available in Word    Simple Steps to MHRT I Certification PDF


Workshop Allocation Form–for DHHS-SAMHS Employees only

Workshop form Word    Workshop form PDF


MHSS Training Notification Form (Updated April 16, 2020)

Training Notification Form Word    Training Notification Form PDF

MHSS Training Validation Form (Updated April 16, 2020)

Training Validation Form Word    Training Validation Form PDF


MHSS Student Information Form  (Updated April 16, 2020)
Student Information Form Word  Student Information Form PDF


MHSS Curriculum Modification Request Form 
MHSS Curriculum Modification Form Word   MHSS Curriculum Modification Form PDF


MHSS Training Policies & Procedures Manual

MHSS Policy & Procedure Manual Word MHSS Policy & Procedure PDF


MHSS Student Evaluation Form 

MHSS Student Evaluation Form Word  MHSS Student Evaluation Form PDF


MHRT/CSP Application Form (Can only be submitted by agency)
UPDATED July 2017

Word CSP Request Form PDF CSP Request Form


MHRT/CSP 2011 Procedural Guidelines

Word CSP Guidelines       PDF CSP Guidelines