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Facilitator Application

NAMI GULF COAST CONNECTION Support Group Leader Training

LOCATION TBD

June 17-19, 2016

 Name:

Address:

City:

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%&'ne:

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Best time t' a$$:

e.erene /Name and emai$ 'r "&'ne:

/%$ease n'te: 'ur re.erene s&'u$d e s'me'ne 3&' )n'3s y'u 3e$$ en'u4& t' re'mmend t&at

y'u e trained t' e'me a .ai$itat'r5

Are y'u a memer '. NAI es: N':

I. yes, L'a$ A..i$iate:

I. no, are y'u 3i$$in4 t' 8'in es: N':

ae y'u eer een 'nited '. a .e$'ny es: N':

I. yes, "$ease e+"$ain:

%$ease te$$ us 3&y y'u 3ant t' e a NAI C'nneti'n e'ery u""'rt ;r'u" *ai$itat'r /'u

an use t&e a) '. t&is "a4e:

NAMI Connection 01.08

8/18/2019 Connection Training: Facilitator Application

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Job e!uire"ents# 

(i$$in4ness t' under4' trainin4 and t' ad&ere t' .ide$ity t' t&e NAI C'nneti'n

e'ery u""'rt ;r'u" m'de$  t' ad&ere t' .ide$ity t' t&e NAI C'nneti'n e'ery u""'rt ;r'u" m'de$ is re

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I %a&e read and understand t%e NAMI eco&ery Support Group Facilitator

 'ob re!uire"ents(

 ))))))))))) *initial+

I understand t%at "y attendance at Facilitator Training does not guarantee t%at I

,ill be certi$ied as a NAMI National eco&ery Support Group Facilitator( ))))))))))) *initial+

I$ selected to attend -

Attending t&e NAI e'ery u""'rt ;r'u" *ai$itat'r Trainin4, and recei&ing certi$icationas a .ai$itat'r, I ac.no,ledge t%at I a" "a.ing a co""it"ent to $acilitating a "ont%lysupport group $or a one year period( 

 >>>>>>>>>>>>>>>>>>>>>

/Date /i4nature

/LEASE FILL OUT AN0 ETUN TO#

 

NAMI Mississippi

1234 Sout%erland Street

Jac.son5 MS 67132

stateo$$ice8na"i"s(org 

NAMI Connection 01.08

mailto:stateoffice@namims.orgmailto:stateoffice@namims.org