Young Adult Connection Facilitator Application

Please fill out the application below.

Thank you!

Please include your contact information

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* 1. Please include your contact information

What is your date of birth?

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* 2. What is your date of birth?

Month/Day/Year
What is the best time to contact you?

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* 3. What is the best time to contact you?

What is the best ways to contact you?

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* 4. What is the best ways to contact you?

Are you a member of NAMI Connecticut? (If no, you can join for as little as $5/year)

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* 5. Are you a member of NAMI Connecticut? (If no, you can join for as little as $5/year)

Do you have your own transportation?

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* 6. Do you have your own transportation?

Do you use public transportation? 

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* 7. Do you use public transportation? 

Are you willing to travel? If yes, how far are you willing to travel?

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* 8. Are you willing to travel? If yes, how far are you willing to travel?

Do you have any allergies/dietary restrictions? If yes, please explain:

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* 9. Do you have any allergies/dietary restrictions? If yes, please explain:

Have you ever attended a NAMI Young Adult Connection Group or another peer-run support group?

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* 10. Have you ever attended a NAMI Young Adult Connection Group or another peer-run support group?

What language(s) do you speak fluently?

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* 11. What language(s) do you speak fluently?

Have you ever been convicted of a felony? (this does not disqualify you  from being a facilitator or volunteering with the NAMI organization.)

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* 12. Have you ever been convicted of a felony? (this does not disqualify you  from being a facilitator or volunteering with the NAMI organization.)

Please note, we require a personal reference.

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* 13. Please note, we require a personal reference.

What inspires you to become a Young Adult Connection Group Facilitator?

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* 14. What inspires you to become a Young Adult Connection Group Facilitator?

What skills or abilities make you a good candidate for the role of a Young Adult Connection Group Facilitator?

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* 15. What skills or abilities make you a good candidate for the role of a Young Adult Connection Group Facilitator?

You must also be willing to use your lived experience in your role as a Young Adult Connection Group Facilitator.For instance, share aspects of your personal story. 
Are you willing to meet this requirement?

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* 16. You must also be willing to use your lived experience in your role as a Young Adult Connection Group Facilitator.For instance, share aspects of your personal story. 
Are you willing to meet this requirement?

Our facilitators receive routine check-ins with the NAMI Connecticut Young Adult Coordinator. You also might be required to take additional/updated training and/or online learning to support the group. Are you willing to meet this requirement?

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* 17. Our facilitators receive routine check-ins with the NAMI Connecticut Young Adult Coordinator. You also might be required to take additional/updated training and/or online learning to support the group. Are you willing to meet this requirement?

How do you define peer support?

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* 18. How do you define peer support?

What is the highest level of school that you have completed?

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* 19. What is the highest level of school that you have completed?

If you have completed a college degree, please include university or college name and area of concentration.

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* 20. If you have completed a college degree, please include university or college name and area of concentration.

Have you taken the Recovery Support Specialist training through Advocacy Unlimited?

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* 21. Have you taken the Recovery Support Specialist training through Advocacy Unlimited?

Please list any other youth and/or mental health related training that you’ve taken. (please answer N/A if you have not taken any other training)

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* 22. Please list any other youth and/or mental health related training that you’ve taken. (please answer N/A if you have not taken any other training)

Please  check all days and times to co-facilitate a YACC groups. (Groups typically run 1-2 hours)

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* 23. Please  check all days and times to co-facilitate a YACC groups. (Groups typically run 1-2 hours)

  11AM 12PM 1PM 2PM 3PM 4PM 5PM 6PM 7PM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please indicate potential locations to facilitate Young Adult Connection Groups.

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* 24. Please indicate potential locations to facilitate Young Adult Connection Groups.

NAMI Young Adult Connection Community offers a variety of support group models. Please select which type of group(s) you would prefer to facilitate.

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* 25. NAMI Young Adult Connection Community offers a variety of support group models. Please select which type of group(s) you would prefer to facilitate.

Voluntary Equal Opportunity Form Disclaimer: 
In an effort to ensure that our facilitator course is as diverse as possible, we are interested in more information.
Please note: Selecting "Prefer not to answer" to any of the following questions does not disqualify you from being a facilitator or volunteering with the NAMI organization.

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* 26. Voluntary Equal Opportunity Form Disclaimer: 
In an effort to ensure that our facilitator course is as diverse as possible, we are interested in more information.
Please note: Selecting "Prefer not to answer" to any of the following questions does not disqualify you from being a facilitator or volunteering with the NAMI organization.

What is your sexual orientation?

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* 27. What is your sexual orientation?

What is your gender expression?

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* 28. What is your gender expression?

What is your ethnicity? (Please select all that apply.)

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* 29. What is your ethnicity? (Please select all that apply.)

Are you a veteran, a spouse of a veteran, or an unmarried surviving spouse of veteran?

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* 30. Are you a veteran, a spouse of a veteran, or an unmarried surviving spouse of veteran?

If yes, were you discharged honorably or released under honorable conditions?

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* 31. If yes, were you discharged honorably or released under honorable conditions?

Have you ever been to an emergency room because of suicidal thoughts or a suicide attempt?

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* 32. Have you ever been to an emergency room because of suicidal thoughts or a suicide attempt?

Have you ever been admitted to a hospital because of suicidal thoughts or a suicide attempt?

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* 33. Have you ever been admitted to a hospital because of suicidal thoughts or a suicide attempt?

Have you lost someone important in your life to suicide?

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* 34. Have you lost someone important in your life to suicide?

Do you have a parent or sibling living with a mental health condition and/or substance use disorder?

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* 35. Do you have a parent or sibling living with a mental health condition and/or substance use disorder?

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