Homefront Interest Form

NAMI Homefront is a free, 6-session educational program for families, caregivers and friends of military service members and vets with mental health conditions.
Based on the nationally recognized NAMI Family-to-Family program, NAMI Homefront is designed to address the unique needs of
family, caregivers and friends of those who have served or are currently serving our country. The program is taught by trained
family members of service members/veterans living with mental health conditions.

NAMI Homefront teaches you how to:
-Manage crises, solve problems and communicate effectively
-Learn to care for yourself, including managing your stress
-Develop the confidence and stamina to support your family member with compassion
-Identify and access federal, state and local services
-Stay informed on the latest research and information on mental health, including posttraumatic stress disorder and substance
abuse
-Understand current treatments, including evidence-based therapies, medications and side effects
-Navigate the challenges and impact of mental health conditions on the entire family

**Please note the time commitment required to participate in the Homefront program. It is important that participants show up
each week over the 6 week period. If you will miss more than 1 or 2 classes, consider waiting until the next class to see if it better
fits with your schedule.

1.First Name
2.Last Name
3.Phone Number
4.Email Address
5.Mailing Address
6.What is your relationship to your loved one with mental illness?
7.What branch of the military did your loved one serve in?
8.Are they receiving services from VHA?
9.Will someone else be joining you? (spouse, child, etc.)
10.If yes, what is their full name and email address?
11.If yes, what is their relationship to your loved one with mental illness?
12.What is your loved one's primary diagnosis?
13.Why do you want to participate in the Homefront class?
14.Are you able to make the time commitment to attend each class over the course of 6 weeks?
15.How do you feel your loved one is doing right now?
16.How do you feel you are doing right now?
17.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?
18.Are there any special needs or considerations we should know about when considering your application? (lack of transportation, handicapped, other limiting concerns)
19.Do you have your own transportation? If no, do you use public transportation?
20.Do you feel comfortable reading out loud to others from written text?
21.Additional comments: