A 50 minute presentation designed for middle and high school students with the goal of raising awareness and changing perceptions about mental health conditions.

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 young adult (age 18-35) living with mental illness or an adult who is either a family member or an individual with a 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: Jessica Miller,

Ending the Silence PresenterApplicationForm

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

Availabilitytopresent(pleasecircle allthat apply): Please note that the majority of the presentations require weekday daytime and afternoon availability.

Weekday daytimeWeekday afternoonWeekday eveningWeekends

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Do youhaveyourowntransportation? Yes_

No Public Transportation? Yes_ No

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Areyouwillingtotravel? Yes No

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

______

What language(s)do youspeakfluently?

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Areyouayoungadult? Age18-30

Age31-35 No

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Which best describes you? Individual with a mental illness Family member

What isyour(or your family member’s)currentdiagnosis?

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AreyoucurrentlyaNAMImember? Yes

No

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If not,areyouwillingtobecomeaNAMImember? Yes

No

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Areyoucomfortable withself-disclosure? Yes No

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Areyouabletomaintaina positiveoutlookandtalk aboutyourexperiencewithout“goingnegative”?

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Yes No

Areyouwilling to undergo a background check if required by NAMI Austin? Yes No

How did you hear about us? ______

ListotherNAMI programsyouhaveparticipatedin andyour rolein theprogram(e.g. trainer,teacher, presenter, etc.):

  1. Whydoyouwant tobeanEndingtheSilence Presenter?
  1. What is it about your (or your family member’s) experience that you think the students will be able to relate to?
  1. What does recovery mean to you?
  1. What are yourviewsontreatment for mental health conditions?

______

Signature of Presenter ApplicantDate

______

Signature of NAMI Austin Executive DirectorDate

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