NAMI Connection Facilitator Application:  Escambia, Santa Rosa, Okaloosa, Walton, Bay, Leon and surrounding Counties ONLY!
NAMI Connection Recovery Support Group is a free, peer-led support group for any adult who has experienced symptoms of a mental health condition. You will share insights from the challenges and successes you have experienced.  The groups are led by trained leaders who've been there!
Sign in to Google to save your progress. Learn more
We are currently looking for individuals in the Northwest Florida areas from Pensacola through Tallahassee!
Application for NAMI Connection Recovery Support Group to be completed by the applicant. 

NAMI Connection Recovery Support Groups are for individuals dealing with the challenges of living with a mental health condition. NAMI Connection Recovery Support groups are peer lead by individuals with mental health conditions and offer hope to those participating. NAMI Connection Support Groups facilitators must be willing to share their perspectives as someone living with a mental health condition and listen empathically to others as they share their stories. 

In order to become a facilitator, one MUST 

* have a mental health condition and currently living in wellness
*must have attended 3 or more Connection support groups
* successfully complete 16 hours of training and receive a facilitator certification. Weekend Zoom Training Available Sat & Sun 9:00 - 5:00 PM. Dates TBD.

If you are interested in becoming a NAMI Connection Recovery Support Group facilitator and you meet the above criteria, please proceed to the next section to begin your application.
Date *
Name *
Email *
Address *
Phone Number *
To protect our online meeting trainees, we ask all participants to provide us with an emergency contact person that we could contact ONLY in the event of an emergency. This information is kept completely confidential - it will never be sold or shared. 
Emergency Contact 
Name, Relationship, Email and Phone Number
All NAMI Program Leaders must be current members. Are you a member of NAMI?
If yes, which affiliate ?
Your answer

Have you participated in 3 or more NAMI Support Group?
If no, are you able to attend at least 3 support groups either Tuesday or Wednesday night on Zoom? *
I prefer to facilitate: *
I am available to facilitate: *
Do you have a mental health condition?
Why do you want to become a NAMI Facilitator? 
What does recovery mean to you?
What are your views on mental health treatment (medication, traditional, non-traditional)?
I understand that all NAMI programs are copyrighted. I will adhere to the Program Operating Policies and Conduct of Conduct, and I will present according to these policies at all times.  

I understand that my attendance at the NAMI Connection Facilitator Training does not guarantee that I will be certified as a Connection Facilitator. If I receive facilitator certification, I understand/agree to serve as a leader in twelve support group meetings during a two-year commitment, or close to these time limits. The time, energy and expense of training each facilitator make this a necessity. It is understood, of course, that unexpected situations may occur that will necessitate compassion and flexibility in this policy. 

I agree to only use approved NAMI Connection materials that are provided in my Leader Manual. I also agree to send all reports to the local NAMI Affiliate Program Coordinator and to the NAMI State Program Director.

Please indicate by typing your name and date.
Are you or have you been a member of the armed forces?

Clear selection
Are you a family member of someone one who has served in the armed forces?

Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy