EmailMe Form - Ending The Silence Presenter Application

NAMI Tallahassee Statewide Ending the Silence Training for:
Name *
First Last
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Email *
Phone *
### - ### - ####
Are you presently or willing to become a NAMI Tallahassee Member? *
Yes, I am currently a member.
No, but I am willing to join.
No. I am a member of another NAMI FL Affiliate
This is a national NAMI program and all presenters are required to be NAMI members. When you become a member of NAMI TALLAHASSEE, you also become a member of the National Alliance on Mental Illness and NAMI-Florida. As such, you will receive their respective publications, The Advocate, published quarterly and NAMI Florida’s electronic communications. Link here to join.
What is your NAMI Affiliate?
Presenter Training date is TBD. Please indicate the days of the week you can make presentations in the schools and youth groups.

Mon Tues Wed Thurs Fri Weekends

Mornings

Afternoons

Evenings
These questions are for planning purposes only.

Yes No

Do you have your own transportation.

Are you willing to travel?

Overnight (if applicable)
Are you a young adult? *
Which best describes you? *
What is your (your family member's) current diagnosis?

Please carefully answer these yes/no questions and the narrative questions that follow.

	Yes	No
Are you comfortable with self-disclosure?
Are you able to maintain a positive outlook and talk about your experience without "going negative"?
Are you willing to undergo a background check (if required)?

1. Why do you want to be an Ending the Silence Presenter? *
2. What is it about your (or your family member’s) experience that you think the students will be able to relate to? *
3. What does recovery mean to you? *
4. What are your views on treatment for mental health conditions? *
List other NAMI programs you have participated in and your role in the porgram (e.g. trainer, teacher, presenter, participant)
Thank you for answering these personal questions.
The information you provide will be kept private and will be used to screen your application. We will follow up with a personal conversation with you.

	Yes	No
Do you have your own transportation.
Are you willing to travel?
Overnight (if applicable)