Thank you for your interest in the NAMI Peer-to-Peer class! 

NAMI Peer-to-Peer is a 8-week education course for people with mental illness. Participants will learn how to create a personalized relapse prevention plan, how to interact with health care providers, develop confidence for making decisions and reducing stress, understand the impacts of symptoms on their life, and access resources to maintain their journey toward recovery.

**Please note the time commitment required to participate in the NAMI Peer-to-Peer program. It is important that participants show up each week over the 8 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.

*** Please do not fill out an application if you are a sexual offender. Instead call the office at (608)249-7188 and we will connect you with other resources ***


Dates: [INSERT DATE]
Times: [INSERT TIME]
Location: [INSERT LOCATION]

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

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

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

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

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* 14. Additional comments:

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