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.

mhrt/Community (MHRT/C) information

Word Format

Adobe Format

MHRT/Community Guidelines-May 2008 MHRT/C Guidelines MHRT/C Guidelines PDF
MHRT/Community Application Form
(Appendix D)
MHRT/C Application MHRT/C Application PDF
MHRT/C Renewal Form (for use starting in 2020) MHRT Renewal MHRT Renewal PDF
MHRT/Community Tuition Reimbursement Form (Appendix E) Tuition Word Tuition form PDF

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

Updated: August 2, 2018--individual forms available for each course

Introduction to Community Mental Health ICMH-Word ICMH-PDF
Psychosocial Rehabilitation PSR-Word PSR-PDF
Interviewing & Counseling I&C-Word I&C-PDF
Crisis Identification & Resolution Crisis-Word Crisis-PDF
Cultural Competence/Diversity Diversity-Word Diversity-PDF
Vocational Aspects of Disabilities VAD-Word VAD-PDF
Substance Abuse with Dual Diagnosis SADD-Word SADD-PDF
Sexual Abuse, Trauma & Recover Trauma-Word Trauma-PDF
Case Management CM-Word CM-PDF
Mental Health & Aging MH&A-Word MH&A-PDF


mhr I information

Word Format

Adobe Format

Provisional Mental Health Support Specialist (MHSS) Handbook 2006

Provo MHSS Word Provo MHSS 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


Workshop allocation form

Workshop Allocation Form--for DHHS-SAMHS Employees only Workshop Form Workshop form PDF

Mental Health Support Specialist (MHSS) Related Forms

MHSS Training Notification Form
UPDATED May 2017
Training Notification Word Training Notification Adobe
MHSS Training Validation Form
UPDATED May 2017
Training Validation Word Training Validation Adobe

MHSS Student Information Form
UPDATED May 2017

MHSS Student Word MHSS Student Adobe
MHSS Curriculum Modification Request Form
UPDATED May 2017
MHSS Modification Word MHSS Modification Adobe
MHSS Training Policies & Procedures Manual
UPDATED May 2017
MHSS Policy & Procedure Manual Word MHSS Policy & Procedure Manual Adobe
MHSS Student Evaluation Form
UPDATED May 2017
MHSS Evaluation Word MHSS Evaluation PDF

Mental Health Rehabilitation Technician/Crisis Service Provider (MHRT/CSP) Related FormS

MHRT/CSP Application Form (Can only be submitted by agency)
UPDATED July 2017
MHRT/CSP Application Word MHRT/CSP Application Adobe
MHRT/CSP 2011 Procedural Guidelines MHRT/CSP Guidelines Word MHRT/CSP Guidelines Adobe