NAMI Glendale Family-to-Family
This form will submit your information electronically when you click on the submit button at the end.
Email address *
Family to Family class application
An 8 week educational program for family members of those living with mental illness
First name *
Last name *
Address, City, Zip *
Cell phone number
Home phone number
Please share something about your loved one who is living with a mental health illness.
This information provided will help to determine if this program meets your needs. NAMI is here to support you and your family.
Name of loved one with illness *
Relationship to you *
Age *
Gender *
Age of onset illness
Diagnosis (if diagnosed) or symptoms *
Medication(s) in use - if unknown write unknown *
Living arrangements
Other information
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