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NAMI Iowa Program Data Reporting - Support Groups
Please report support group data here. Questions? Please call NAMI Iowa at 515-254-0417.
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* Indicates required question
Email
*
Your email
NAMI Affiliate
*
Choose
NAMI Black Hawk County
NAMI Carroll County
NAMI Central Iowa
NAMI Dubuque
NAMI Greater Mississippi Valley
NAMI Iowa
NAMI Johnson County
NAMI Linn County
NAMI North Iowa
NAMI Northeast Iowa
NAMI Northwest Iowa
NAMI Polk County Iowa
NAMI South Central Iowa
NAMI Southeast Iowa
NAMI Southwest Iowa
Emerging Affiliates Only: County
Your answer
NAMI Program
*
Connection Recovery Support Group
Family Support Group
Presentation Language
*
English
Spanish
Chinese
French
Italian
Arabic
Vietnamese
Mandarin
Other:
Facilitator 1 Full Name
*
Your answer
Facilitator 2 Full Name
*
Your answer
Date of group meeting
*
MM
/
DD
/
YYYY
Start Time of Support Group
*
Time
:
AM
PM
End Time of Support Group
*
Time
:
AM
PM
How Conducted
*
In-Person
Virtual
Hybrid (in-person & virtual)
Facility Location (Building Address) [In-Person Only]
Your answer
# of Participants
*
Your answer
# of Veterans, Active Duty or Related
*
Your answer
# of First Time Participants
*
Your answer
Partnership with Veterans Administration
*
Yes
No
Additional Information (if needed)
Your answer
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