EmailMe Form - NAMI-Florida Training Approval Request

EmailMeForm

Affiliate name: *

Training dates: *

Contact person for training: *
First Last

Email *

Phone preference: *
### - ### - ####

Signature Program
Select the program which applies to this request.

Program: *
NAMI Basics: 2 full days
NAMI Connection: 2-day workshop or states may use the 3-day model
NAMI Ending the Silence: 2 - hour online training. Followed by an in - person practice session within 30 days
NAMI Family-to-Family: 2.5-day or 2-day training workshop
NAMI Family Support Group: 2-day workshop or states may use the 3-day model
NAMI Home Front: Teletraining - Candidates must be F2F or Basics teachers
NAMI In Our Own Voice: Online presenter training to be completed before a 1-day in-person training.
NAMI Peer-to-Peer-1.5-day training workshop
NAMI Provider: 1.5-day training workshop
NAMI Smarts

Training site and address: *

Expected number of participants: *

Course Trainers and Coordinators:
Trainer #1:
National requires at least 1 state trainer (max of 6 trainees per trainer) and 1 designated affiliate coordinator for the following programs: Family Support Group, Connection and Provider (max of 6 trainees per trainer up to a total of 18 trainees).

Trainer #1: Name, email and preferred phone # *

Trainer #2:
National requires two trainers for the following programs: Basics; Family-to-Family; Home Front; Peer-to-Peer. In Our Own Voice trainings require 2 state trainer plus 1 designated coordinator (up to a total of 16 trainees). A second trainer is required for Family Support Group, Connection,and Provider if trainees exceed the max per trainer.

Trainer #2: Name, email and preferred phone #

Trainer #3:
National requires three trainers for both the Family and Connection Support Group trainings if there are over 12 trainees. This would equal 1 trainer for every 6 trainees - not to exceed 18 trainees.

Trainer #3: Name, email and preferred phone #

Coordinator:
National requires an on-site coordinator must be availabile for the following programs: Peer-to-Peer, In Our Own Voice and Connection. If this individual is someone other than the primary contact listed above, please provide the following information.

All affiliates are encouraged to recruit a volunteer to assist teachers in the coordination of their signature programs.

Coordinator: Name, email and preferred phone #

Outside Affiliates:
If this training is offered to outside affiliates, the sponsoring affiliate will be responsible for setting a registration fee, what is included in the fee and notification to interested affiliates.

NAMI Florida's Education Committee will list all approved courses offered to outside affiliates through the NAMI Florida website.

Is this training open to outside affiliates? *

Select "Yes" or "No" on the dropdown list.

*If you indicated "Yes" above, include your registration fee below.

Registration fee for outside affiliates and what it includes (materials, meals?)

Reporting:
The indivdual below is responsible for reporting training data to NAMI Florida's Education Committee within one week of the training. If not listed above please include an email address and phone #.

Data Reporter: Name, email and preferred phone # *
It is imperative that all completed classes are reporting on the nami.org education data collection site. If you need assistance with this, please refer to the attached instructions in your manual. NAMI FL and NAMI National will be able to collect their necessary data from there. NAMI Florida will no longer be collecting copies of teacher or participant evaluations, but requests a copy of the final class list. Your affiliate will want to retain the final class list as part of the affiliate's records.

Screening Process:
Please indicate the individual responsible for screening applicants and describe the screening process. If the individual is different than the contact or coordinator listed above, include their name and email address. Candidates from outside affiliates must have the approval of either the affiliate president or executive director.

Screening Coordinator: *
This box is limited to 250 words.

Agreement:
As a designated representative of the above named affiliate, I understand that all NAMI programs are copyrighted.

The named affiliate will adhere to the 2019 Program Operating Policies and Code of Conduct (as linked above) and offer this training according to these policies as outlined in the course materials.

Affilate Agreement *

Yes No

I am in agreement with the above terms.

Contact for additional information:
Your submission will automatically be forwarded to the members of the Education Committee. Following approval, you will be contacted by Cindy Foster at Programs@namiflorida.org to coordinate notification to outside affiliates and training requirements.

Date Time *
MM / DD / YYYY

Signature Program

Course Trainers and Coordinators: Trainer #1:

Trainer #2:

Trainer #3:

Coordinator:

Outside Affiliates:

Reporting:

Screening Process:

Agreement:

Contact for additional information:

Course Trainers and Coordinators:
Trainer #1: