Thank you for your interest in the Honest, Open, Proud workshop!

Honest, Open, Proud is a five- week workshop for teens, which guides individuals with lived experience through a process of learning about and applying principles of self disclosure regarding their mental illness and recovery.

**Please note the time commitment required to participate in the Honest, Open, Proud program. It is important that participants show up each week over the 5 week period. If you will miss more than 1 class, consider waiting to sign up for the next session to see if it better fits with your schedule.

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* 1. First Name

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* 2. Last Name

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* 3. Phone Number

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* 4. Email Address

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* 5. Mailing Address

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* 6. Do you have a primary diagnosis?

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* 7. If yes, what is your primary diagnosis?

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* 8. Why do you want to participate in the NAMI Peer-to-Peer class?

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* 9. Are you able to make the time commitment to attend each class over the course of 5 weeks?

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* 10. How do you feel you are doing right now?

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* 11. Do you feel you can participate in a modeled or structured program? Do you understand the role of the facilitators is not to give medical advice to anyone participating?

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* 12. Are there any special needs or considerations we should know about when considering your application? (lack of transportation, handicapped, other limiting concerns)

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* 13. Do you have your own transportation? If no, do you use public transportation?

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* 14. Do you feel comfortable reading out loud to others from written text?

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* 15. Additional comments:

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