A monthly support group for family members and friends of individuals living with a mental illness.

In order to be eligible for this program you must meet all of the following requirements. Please read and check each box below:

¨ I am a family member or caregiver of someone who lives with a mental illness.

¨ I can commit to facilitating a support group for one year. The time, energy and expense of training each facilitator makes this a necessity. It is understood, that unexpected situations may occur that will necessitate compassion and flexibility in this policy.

¨ I like to co-facilitate a group.

¨ I have a welcoming personality and am interested in sharing information with families as they face the challenges of living with mental illness.

¨ I am a NAMI Austin member (or willing to become a member).

¨ I agree to abide by NAMI policies and procedures.

¨ I must make every attempt to fulfill my volunteer commitment as outlined in the training application.

¨ I understand that participation in training does not guarantee certification. NAMI state-level trainers determine if an individual has met all criteria.

Submit this completed application directly to: Kathy Bentz,

NAMI Family Support Group Facilitator Application

Name:
Address:
Phone: / Alternate Phone:
Email:
Best time to call:
NAMI Affiliate: / NAMI Austin

1. Do you have a loved one with a mental illness? 1 YES 1 NO (to facilitate, you must answer yes)

2. What is your relationship to your loved one with a mental illness? (please check which applies)

1 Parent 1 Sibling 1 Spouse/Significant Other 1 Child

1 Other ______

3. What is your relative’s diagnosis? (Check all that apply)

1 Schizophrenia 1 Schizoaffective 1 Bipolar 1 OCD 1 Major Depression

1 Post-Traumatic Stress Disorder 1 Panic/Anxiety Disorder

1 Borderline Personality Disorder 1 Other______

4. This relative has been ill for ______years. Are they currently stable? 1 YES 1 NO

5. Are you a current member of NAMI? 1 YES 1 NO

If yes, list the affiliate you are associated with: ______

6. Have you taken the NAMI Family-to-Family class before? 1 YES 1 NO If so, what year? ______

7. Do you know who you want to facilitate with? 1 YES 1 NO Who? ______

8. Do you know where you want to facilitate? 1 YES 1 NO Where? ______

9. Are you willing to facilitate in other areas? 1 YES 1 NO Where? ______

10. Do you need any special accommodations that we should be aware of? If so, please specify.

______

11. Availability to facilitate (please circle all that apply): Please note that groups require either

weekday evening or Saturday morning availability.

Weekday evening Saturday morning

12. How did you hear about us? ______

Please answer in a few sentences

12. Why do you want to be a NAMI Family Support Group Facilitator?

______

Signature of Facilitator Applicant Date

______

Signature of NAMI Austin Executive Director Date

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