NAMI Ending the Silence Interest Form
Thank you for your interest in becoming a NAMI Ending the Silence presenter.  NAMI Ending the Silence is an engaging presentation that helps middle and high school aged youth learn about the warning signs of mental health conditions and what steps to take if you or a loved one are showing symptoms of a mental health condition.  If you are interested in being involved in NAMI Ending the Silence, we ask that you please fill out this short screening tool so we can learn more about you and your connection to mental health conditions.

Please be as thorough as you can in your responses.

Thank you!
Email *
Name: *
Full Mailing Address:
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Phone:
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Alternate Phone (if applicable):
Email:
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What is the best time of day to reach you?  Choose all that apply:
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Required
Who is your NAMI affiliate?
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What time of day and day of the week are you available to do presentations?  Please check all that apply:
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Required
Do you have your own transportation?
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If you do not have your own transportation, do you use public transportation?
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Are you willing to travel?
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Would you be willing to stay somewhere overnight for a presentation, if needed?
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What languages, other than English, do you speak fluently?
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Are you a young adult?
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Which of the following best describes you?
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What is your (or your loved one's) current diagnosis?
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Are you currently a NAMI member?
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If you are not a NAMI member, are you willing to sign up for membership?
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Are you able to maintain a positive outlook and talk about your experience without "going negative"?
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Are you willing to undergo a background check if required by your NAMI Affiliate?
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If you have been a part of other NAMI programs, please list them below along with your role (e.g. trainer, teacher, presenter, etc.):
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Why do you want to be an Ending the Silence Presenter?
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What is it about your (or your family member's) experience that you think the students will be able to related to?
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What does recovery mean to you?
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What are your view on treatment for mental health conditions?
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Is there anything else about your application that we should know?
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