NAMI Pinellas County Summer 2023 Family-to-Family Education course

What is NAMI Family-to-Family?

NAMI Family-to-Family is a free education program for family members who have a loved one living with a mental health condition. In this program the term family is viewed from a broad perspective to include parents, siblings, spouses, adult sons and daughters, care-givers, partners and significant others. The course is designed to help all family members understand and support their loved one with a mental health condition while maintaining their own well-being. The course includes information on illnesses such as schizophrenia, bipolar disorder, major depression and other mental health conditions. Thousands of families describe the program as life-changing. The program is taught by trained teachers who are also family members and know what it is like to have a loved one living with mental illness. In May 2013 the program was added to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence-based Programs and Programs

Online viz Zoom

Question Title

* 1. In order to capture our applicant culture, please check any of the below boxes that you identify with:

I am a Family member to an individual with a mental illness

I am a Parent to an individual with a mental illness

I am a Sibling to an individual with a mental illness

I am a Spouse /Partner to an individual with a mental illness

I am a loved one to someone who has both Substance use disorder (addiction) and Mental health diagnosis

Prefer not to answer

Question Title

* 2. Contact Information

Full Name *

Employer

Home Address *

City/Town *

State/Province *

ZIP/Postal Code *

County *

Email Address *

Phone Number *

The following questions are to help us identify who is participating in our programs. Please answer as many questions as you feel comfortable with. Participation in answering these demographic questions is voluntary.

Wednesdays: 6:30-8:30

June 21, 28
July 12, 19, 26
August 2, 9, 16

Question Title

* 3. In order to capture our applicant culture, please check any of the below boxes that you identify with:

I am a Family member to an individual with a mental illness

I am a Parent to an individual with a mental illness

I am a Sibling to an individual with a mental illness

I am a Spouse /Partner to an individual with a mental illness

I am a loved one to someone who has both Substance use disorder (addiction) and Mental health diagnosis

Prefer not to answer

Question Title

* 4. Gender (select the information that most describes you)

Male

Female

Non-binary/third gender

Agender

Cisgender

Gender Fluid

Genderqueer

Transgender Female

Transgender Male

Prefer not to answer

Prefer to self-describe

Question Title

* 5. What is your age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Prefer not to answer

Question Title

* 6. Race (select the information that most describes you)

American Indian or Alaska Native

Asian or Asian American

Black/Brown

White

Native Hawaiian or other Pacific Islander

Other or Multi-Racial

Prefer not to answer

Prefer to self-describe

Question Title

* 7. Ethnicity (select the information that most describes you)

Hispanic or Latino

Non-Hispanic, Latino, or Spanish

Prefer not to answer

Prefer to self-describe

Question Title

* 8. Sexual Orientation (select the information that most describes you)

Asexual

Bisexual

Gay/Lesbian/Homosexual

Pansexual

Straight/Heterosexual

Prefer not to answer

Prefer to self-describe

Question Title

* 9. Please share a sentence or two outlining your lived experience as a family member of a person who has a mental health condition or a MH and Substance use disorder ?

Question Title

* 10. What do you hope to gain from this course?

Question Title

* 11. All NAMI signature programs are built around the principles of mutual trust and respect among participants and leaders. NAMI program leaders are trained in the importance of creating and maintaining an atmosphere of respect in classes that is conducive to participants’ ability to gain valuable information and support regarding mental illness.

Participants must also understand the code of conduct and adhere to the key concepts of the program.

Please read and review and check each box: I attest to

Consider becoming a member of NAMI Pinellas by paying the membership fee of $5.00/ $40.00/ $60.00

Have positive regard for mutual support while participating in class.

Understanding that this program is built around the principles of mutual trust and respect among participants.

Understanding the importance of contributing/sharing that is conducive to participants’ ability to gain valuable information and support regarding mental illness.

Assurance of complete confidentiality regarding any information shared by participants about themselves or others.

Question Title

* 12. How did you find out about NAMI Family to Family Program?

Family Member or Friend

Health Care Provider

nami-pinellas.org/ NAMI Affiliate web site

Virtual NAMI Publication / e-mail/ constant contact

Social media

Other (please specify)

Question Title

* 13. Person to notify in Case of Emergency:

Name and Relationship to Applicant:

Email Address:

Phone Number:

Thank you for your interest in the NAMI Family-to-Family course. Once your application has been received, we will likely invite you to join the class and schedule a time to provide program materials for you.

Jessica Kushner
Senior Program Coordinator at NAMI Pinellas County Florida, Inc.
O: 727-826-0807 | Helpline: 727-791-3434
nami-pinellas.org

Please click the "Done" button below to submit your application. Your application for registration is complete!