NAMI Wisconsin
Mental Health Chat Training
Date: September 14th, 2019
Location: NAMI Fox Valley Office

This form must be completed by August 14th, 2019.

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* 1. General Information

Please sign your initials in agreement next to each of the following statements:

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* 2. I understand that Mental Health Chat is a Wisconsin developed program. Our affiliates will refer to this presentation as "Mental Health Chat" on all printed material.

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* 3. I understand this Program will adhere to the NAMI policies. (Among others, these policies state that the affiliate and the teachers will: honor the copyright status and the process for obtaining permission to reproduce handout materials; not charge a fee for the presentation; maintain the presentation as taught; send only NAMI members to the presenter training, and only have certified members provide the presentation. )

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* 4. I understand that NAMI Wisconsin will cover the costs related to the training, including meals during the training and all training materials. Our affiliate or sponsored participants will be responsible for travel to and from the training, all lodging and meals outside of the time of the training. 

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* 5. I agree that it is the responsibility of our affiliate to assist the presenter in coordinating with elementary school staff, arrange for publicity and cover incidental costs. I also agree that all future materials needed to do the presentation are the financial obligation of the affiliate.

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* 6. I understand that the individual I send has to have the ability to read aloud, speak in front of a group and be effectively talk to elementary students in a compassionate way.

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* 7. I certify the presenters from our affiliate is a Family Member of OR someone who identifies as living with a mental illness.

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* 8. SIGNED: please enter your name as a signature.  Thank you!

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* 9. Please provide a list below of members attending this training that have your affiliates approval.  

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