NAMI CA MENTAL HEALTH 101 PRESENTER APPLICATION

Questions? Email: zuleima@namica.org

This is the application survey to apply for the MH101 PRESENTER training in Solano County in March 2019. Please review the flyer for the program qualification prior to applying. You will receive an email on before March 15 if your application was accepted for the training.

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* 1. Contact

Name *

Local NAMI Affiliate *

Full Address *

Phone Number

Email Address *

Age? *

Gender Identity? *

What language(s) are you fluent in? *

Please specify the cultural and/or ethnic background you identify with. *

MH101 Presenters must be NAMI members. Are you a NAMI member or will you be a NAMI member? *

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* 2. Presenters must complete the entire training in order to be certified. The training will be Saturday (9:00AM-4:00PM) and Sunday (9:00AM-4:00PM).

Can you make it to the entire training?

Yes

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* 3. Presenters must either be a:

- peer/person with a mental health condition
- a supporter of a loved one who has a mental health condition.

Select the following that you identify as (you may pick more than one):

an individual with "lived experience"/mental health condition

a supporter/loved one of an individual with "lived experience"/mental health condition

neither

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* 4. If you are planning to attend the training, we expect that you will deliver a Mental Health 101 presentation.

Can you commit to delivering at least one Mental Health 101 presentation after certification?

yes

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* 5. Are you trained as a Presenter/Mentor/Facilitator for another NAMI program? (If so, what is the program name?)

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* 6. Each Mental Health 101 presentation requires two presenters: a person with lived experience and a family member/supporter of a loved one with lived experience.

Is there another NAMI member from your local affiliate that is trained or is applying?

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* 7. Have you discussed this training with your NAMI affiliate leader. If yes, who?

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* 8. One of our goals is to eliminate cultural and racial barriers. What is your race/ethnicity/background (Check any that applies)

African American/Black

American Indian/Native American/Alaskan Native

Asian American/Asian

Latino/a/x/Hispanic

Middle Eastern

Pacific Islander

Caucasian/White/European

Decline to State

Other (please specify)

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* 9. Please briefly tell us how you propose to successfully introduce NAMI California’s MH101 Program to one or more of the following culturally diverse communities in your region: African American, Asian & Pacific Islander, Latina/o/x, LGBTQ+, Native American, immigrants/refugees, or general population?

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* 10. Lived Experience Presenters will write and share their story of living with mental illness and achieving/maintaining recovery/healing.

Supporter Presenters will write and share their story of supporting an individual living with mental illness and achieving/maintaining recovery/healing.

(Presenters will be trained step by step to help prepare their story.) Describe your recovery process or how you help your loved one stay in recovery.

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* 11. Please list any dietary restrictions or special accommodation needed.

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* 12. Thank you for your application. You will be notified by email before March 15, 2019 if your application meets the program requirements.

Do you have any questions about the training/presentation?

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* 1. Contact

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* 2. Presenters must complete the entire training in order to be certified. The training will be Saturday (9:00AM-4:00PM) and Sunday (9:00AM-4:00PM).Can you make it to the entire training?

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* 3. Presenters must either be a:- peer/person with a mental health condition - a supporter of a loved one who has a mental health condition. Select the following that you identify as (you may pick more than one):

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* 4. If you are planning to attend the training, we expect that you will deliver a Mental Health 101 presentation.Can you commit to delivering at least one Mental Health 101 presentation after certification?

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* 5. Are you trained as a Presenter/Mentor/Facilitator for another NAMI program? (If so, what is the program name?)

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* 6. Each Mental Health 101 presentation requires two presenters: a person with lived experience and a family member/supporter of a loved one with lived experience. Is there another NAMI member from your local affiliate that is trained or is applying?

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* 7. Have you discussed this training with your NAMI affiliate leader. If yes, who?

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* 8. One of our goals is to eliminate cultural and racial barriers. What is your race/ethnicity/background (Check any that applies)

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* 11. Please list any dietary restrictions or special accommodation needed.

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* 12. Thank you for your application. You will be notified by email before March 15, 2019 if your application meets the program requirements. Do you have any questions about the training/presentation?

* 2. Presenters must complete the entire training in order to be certified. The training will be Saturday (9:00AM-4:00PM) and Sunday (9:00AM-4:00PM).

Can you make it to the entire training?

* 3. Presenters must either be a:

- peer/person with a mental health condition
- a supporter of a loved one who has a mental health condition.

Select the following that you identify as (you may pick more than one):

* 4. If you are planning to attend the training, we expect that you will deliver a Mental Health 101 presentation.

Can you commit to delivering at least one Mental Health 101 presentation after certification?

* 6. Each Mental Health 101 presentation requires two presenters: a person with lived experience and a family member/supporter of a loved one with lived experience.

Is there another NAMI member from your local affiliate that is trained or is applying?

* 12. Thank you for your application. You will be notified by email before March 15, 2019 if your application meets the program requirements.

Do you have any questions about the training/presentation?