Massachusetts Peer Recovery (PR) Exam Form

Massachusetts IC&RC Peer Recovery (PR) Exam Form
In order to sit for the IC&RC Peer Recovery exam, please complete the form below and provide payment for the $125.00 examination fee.

You must complete your exam within one year (12 months) of the date listed in your pre-registration letter.

IMPORTANT NOTE: The name on your valid, government-issued ID must exactly match the first and last name you enter below. If your test registration and ID do not exactly match, you will be turned away from the testing center and will forfeit your testing fees.
Name

First NameLast Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please click the link below to review the Code of Ethics.

IC&RC Peer Recovery Code of Ethics
I attest that I have read and accept the Peer code of ethics.
I attest that I have a High School Diploma, GED, or higher. Please note that documentation of a High School, Diploma, GED, or higher will be required when applying for the PR certification.

Massachusetts Exam

PR Exam Fee

$125.00

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Within 10 business days of submitting your payment, you will receive information from IC&RC that outlines how to schedule your examination.
Signature
Should be Empty:

Massachusetts IC&RC Peer Recovery (PR) Exam Form