Young Adult Connection Facilitator Application

Please fill out the application below.

Thank you!

* 1. Please include your contact information

* 2. What is your date of birth?


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

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

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

* 6. Do you have your own transportation?

* 7. Do you use public transportation? 

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

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

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

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

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

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

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

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

* 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?

* 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?

* 18. How do you define peer support?

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

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

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

* 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)

* 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

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

* 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.

* 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.

* 27. What is your sexual orientation?

* 28. What is your gender expression?

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

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

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

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

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

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

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