Connection Support Group Facilitator Training Application

March 23 & 24, 2024  Via Zoom video conference

Sign in to Google to save your progress. Learn more
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 Connection Support Group facilitator:

Connection Facilitator Requirements:

·         Identify as being in recovery from a mental health disorder

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

·         Participate in a NAMI Connection 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

·         Authorize a criminal background check

·         Adhere to the NAMI Connection Peer Support Group model when facilitating a group

·         Commit to facilitating a support group for a minimum of one year

·         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

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

Are you an individual living with mental health disorder?
Your diagnosis is:
Have you ever been convicted of a felony?

If yes, please explain.

Have you participated in a NAMI Connection Support Group?

If yes, month and year of the last Connection 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 Connection Peer Support Group facilitator:


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

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:

Clear form
Never submit passwords through Google Forms.
This form was created inside of NAMI Oregon. Report Abuse