Application

This is an application to become a Nationally Certified ROMA Trainer (NCRT), or a Nationally Certified ROMA Implementer (NCRI), under the National Peer to Peer (NPtP) Training and Certification Project.


WARNING! Caps lock is ON.
Please fill out the application form below.
Items in RED are mandatory.
First Name
Middle Initial
Last Name
Application TypeNationally Certified ROMA Trainer (NCRT)
Nationally Certified ROMA Implementer (NCRI)
Phase 2 Cohort TrainingCheck the Event tab for upcoming dates. If there is a cohort with dates that fits your schedule, please indicate that in the box below. If you want to work with others in your state or region, enter that information in the box.
You can also leave this section blank and we will put you in the next available cohort.
Job Title
Duration of Current Position
Agency Name
Is this is a state CSBG office? Yes   No
Are you Association Staff? Yes   No
 
AGENCY INFO
Provide a mailing address that can be used to send material to you.
Be sure you have entered the address correctly, including the zip code. Check it twice to be sure!
If you prefer material mailed to your personal address, tell us via the "Contact Us" tab.
Address
Address 2, ex, Suite
City
State
Zip Code
Telephone + Extension
Cell Phone
Email
 
PERSONAL INFO
Address
Address2
City
State
Zip Code
Telephone
Cell Phone
Email
 
REFERENCE CONTACT INFO
I understand my application to become a Certified ROMA professional must be supported by my agency, the state CSBG Office and the Community Action Association.
Listed below are the names and email addresses to contact to verify this support:
My Agency Contact
My Agency Contact Email
State CSBG Office Contact
State CSBG Office Email
Community Action Association Contact
Community Action Association Email
 
SUPPORTING INFO
Please state why you want to become a Certified ROMA Trainer or Implementer:
Upload Your Resume
 

If you have questions, please contact Barbara Mooney, NPtP Project Director,
724-852-2272 or use the form under the Contact Us tab.

 
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