Monadnock Peer Support New Member Form

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Thank you for your interest in becoming a member of Monadnock Peer Support! Becoming a member is the next step in becoming a part of our community and entitles you to vote in the MPS Board of Directors during Annual Meeting. Your membership is completely free and the information we request on this form is confidential. As a member-driven community, it is our hope that becoming a member will support you in furthering your peer support journey and in discovering what wellness and recovery mean to you.

According to our contract with the Department of Health and Human Services, the following is a definition of individuals who may utilize our Peer Support Center: "...any individual, 18 years of age or older, who self identifies as a recipient, former recipient, or is at significant risk of becoming a recipient of publicly funded mental health services."

Please download and read the following forms*:

MPS Mission and Values/Rights and Responsibilities - https://drive.google.com/file/d/1KelMTzFmUwHftqcaH3zwHWaBwNcC4gEj/view?usp=sharing

HeM 315 (Rights of Persons Receiving Peer Support) - https://drive.google.com/file/d/1R1uy4QNDb7Gz_jPhv_eFxypJz2u6jtrN/view?usp=sharing

HeM 402 (Defining Peer Support in NH) - https://drive.google.com/file/d/10DV9Rv13MWQvJncLwDUY7NSvZp6cKALA/view?usp=sharing

*These forms will also be emailed to you after submitting this form.

Email *

What is your full name? *

What is your preferred name? *

How did you hear about us? *

What are your goals? *

What are your interests?

Gender *

Female

Male

Nonbinary

Other:

Mailing Address (please include, street, street #, PO Box if applicable, city, state, and zip code) *

Phone Number *

Date of Birth *

YYYY

Race/Ethnicity *

I have been advised of my rights and have received a copy of He-M 315, link located at the top of this page. I pledge to abide by the Guidelines, Mission, Values, and Rights and Responsibilities of Monadnock Peer Support. Please electronically sign by typing your full name. *

Would you like to receive regular outreach calls from employees / Members / Volunteers? *

Yes

Would you like to receive our monthly newsletter via email? *

Yes

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