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 Guidelines-May 2019 (Coming soon)

  MHRT/C Guidelines (10/2/19) PDF


MHRT/Community Application Form (Appendix D)

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


MHRT/Community Knowledge Competencies

MHRT-C-Competencies PDF


MHRT/C Renewal Form (for use starting in 2020)

MHRT Renewal    MHRT Renewal 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

Domain 6-PDF


Domain 7: Cultural Competency

Domain 7-PDF


Domain 8: Vocational Support

Domain 8-PDF


MHRT Work Experience Verification Form

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

 Work Experience Verification   Work Experience Verification

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–for DHHS-SAMHS Employees only

Workshop Form    Workshop form PDF


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

MHSS Evaluation Word  MHSS Evaluation PDF


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