Ending The Silence
Thank you for your interest in hosting a free Ending the Silence presentation. Please fill out the short form below so we can find a presenter that can meet your needs.
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School/Organization Name *
School/Organization Leader Name and Title *
Please list the name and title of the decision maker (principal, superintendent, etc) who is authorized to schedule this training.  
School/Organization Zip Code *
My school/organization is interested in: *
Would you be interested in scheduling an in-person* or virtual training ? *
Contact Information
Please provide the name and email address of the best person with whom NAMI Indiana and our presenters can coordinate presentation details.
Name *
Email Address *
Phone
Presentation Needs
What is your desired presentation date and time? *
 If several dates/times would work for you, please list up to three options ordered by preference.
How many presentations would you like? *
About how many students will we be presenting to?  *
Does your school or organization have a classroom available on the training day that can accommodate up to 25 participants? *
If yes, would the following  items be  available for instructor use?
Please check all that apply.
Grade of particpants: *
Please check all that apply.
Required
Does your school or organization have a printer available to print off resources for participants? *
Do you have any special requests or questions?  List them here or email rdixon@namiindiana.org.
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