September 2024 Newsletter

Navigating the various MHRT/C forms can be tricky. This guide helps you choose the correct form based on your specific needs. Each form will be linked to its corresponding PDF version.

MHRT/C Application Form (Appendix D)

Note: Do not use this form to submit continuing education paperwork for your Full MHRT/C renewal. For that, use Appendix G.

• Use this form for your initial MHRT/C application under Pathways A, B, or C.
• It is also required whenever submitting additional paperwork to meet any missing Domain requirements.

Downloadable Appendix D Form

Relevant Work Experience Verification Form (Appendix E)

This form is for applicants seeking a Provisional MHRT/C (Pathway C) based solely on relevant adult behavioral health work experience. Examples include roles such as MHRT I, peer support services, or adult substance abuse services.

• To complete this form, have the HR office of the agency where you gained the experience fill it out.
• If your job title does not clearly reflect one of these areas, ask the HR office to include a description in the notes section.

Downloadable Appendix E Form

Credit for Work Experience Form (Appendix F)

This form allows you to meet specific Domain requirements through relevant work experience. You must have six months of adult behavioral health work experience to use this process. Each Domain has its own form, except for Domains 1 and 3, which cannot be met through this process.

• Your clinical supervisor must complete the form with a narrative explaining how your work experience satisfies the Domain’s knowledge competencies.
• If you do not have clinical supervision, your administrative supervisor can complete it, but your HR office must sign off to confirm that you do not receive clinical supervision.

You can use this process for up to four of the following Domains, provided you have sufficient experience:

• Downloadable Domain 2 Form
  
• Downloadable Domain 4 Form
  
• Downloadable Domain 5 Form
  
• Downloadable Domain 6 Form
  
• Downloadable Domain 7 Form
  
• Downloadable Domain 8 Form
  

MHRT/C Certificate Renewal Application (Appendix G)

Note: Do not use this form to submit Domain completion paperwork for your second Pathway B or C MHRT/C certificate. For that, use Appendix D.

• Use this form if you are renewing your Full MHRT/C certification.
• Once you’ve earned the two-year Full MHRT/C, you must complete continuing education every two years for renewal. Submit this form along with your continuing education certificates.

Downloadable Appendix G Form