Family Support Group Facilitator Training Application

February 17-18, 2024  Via Zoom video conference

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Name: *
Home Address: *
City/State/Zip: *
Phone: *
Email: *
Emergency Contact (someone who will be physically near you during the training) -- Name:
 *
Emergency Contact -- Phone:
 *
Emergency Contact -- relation to you (e.g., spouse, friend, parent, etc.):
Primary NAMI affiliate for which you plan to serve as a Family Support Group facilitator:
 *

Family Support Group Facilitator Requirements:

·         Have a close family member (partner/spouse, parent, child, or sibling) who lives with a serious mental illness

·         Be 18 years old or older at the start of the training

·         Participate in a NAMI Family Support Group prior to the training

·         Be recommended for this volunteer role by the leadership of your local NAMI affiliate

·         Be available for a brief applicant screening by video conference or phone

·         Attend the entire 16-hour facilitator training

·         Commit to maintain fidelity to NAMI’s support group model.

·         Commit to begin to co-facilitate a support group within 6 months of training.

·         Commit to facilitating a support group for at least 12 months over the next two years

·         Provide participant data to NAMI Oregon following each support group meeting

·         Be willing to identify potential new facilitators from support group participants

·         Have a positive regard for or personal experience with mutual support

·         Be or become a member of NAMI prior to the training

·         Authorize a criminal background check

Please check box to indicate that you have read and understand the above requirements.

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Required
Your ill family member is your (parent, sibling, etc.)? *
Your family member's diagnosis is:
 *
Have you ever been convicted of a felony?
 *

If yes, please explain.

Have you participated in a NAMI Family Support Group?

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If yes, month and year of the last Family Support Group meeting you attended:  
Have you taken other NAMI courses or trainings? if yes, please list below.

Please briefly describe why you want to become a Family Support Group facilitator:

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Once trained, you would be willing to facilitate support groups:

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Device you plan to use to participate in the training:
 *

This training requires significant amounts of reading, writing, and speaking. Do you have any physical or other issues that affect your ability to carry out these activities? If yes, please explain.

Please list any need special for accommodations:

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