URLThis field is for validation purposes and should be left unchanged.Type/Category(Required)SelectRequestTrainingRequest(Required)SelectAbout NAMI Vermont Presentation RequestEnding the Silence Presentation RequestFaithNet Presentation RequestFamily Voices Presentation RequestIn Our Own Voice Presentation RequestMental Illness & Recovery Workshop RequestProvider RequestPlease select the format for your Provider program(Required)SelectSeminar (4 hours)Course (15 hours)Which Ending the Silence presentation are you requesting?(Required)Ending the Silence for StudentsEnding the Silence for School StaffEnding the Silence for FamiliesTraining(Required)SelectConnection Recovery Support Group Facilitator TrainingEnding the Silence Presenter TrainingFamily Support Group Facilitator TrainingFamily-to-Family Teacher TrainingIn Our Own Voice Presenter TrainingMental Illness & Recovery Teacher TrainingProvider Course Presenter TrainingThis field is hidden when viewing the formRegisterSelectBecome a MemberBecome a VolunteerNAMI Homefront CourseName(Required) First Last PronounsWhat is your role at the school where the presentation is being requested?(Required)Organization name and type(Required)School name(Required)Name and type of place of worship(Required)Email address(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone number(Required)Audience size(Required)What is the approximate age range of the students?(Required)Requested presentation date(Required) MM slash DD slash YYYY Alternative presentation date(Required) MM slash DD slash YYYY Would you like an in-person or virtual presentation?(Required)In-personVirtualDo you have a diagnosed mental health condition? If so, what is it?(Required)Are you willing to present your personal story of living with a mental health condition to others?(Required) Yes No Are you willing to provide us with a professional or personal contact reference if needed?(Required) Yes No Please provide contact reference name and phone number.(Required)We will notify you if we need to contact your reference.Are you willing to present your personal story of living with a mental health condition to middle- and high-school students, their family members, and school staff?(Required) Yes No I would like to be trained as: Lead Presenter: ETS for Students Lead Presenter: ETS for Staff Lead Presenter: ETS for Families Young Presenter (age 18–35) How old are you?(Required)Do you have reliable transportation for traveling to/from presentations?(Required) Yes No NAMI Vermont provides mileage reimbursement at the IRS rate.Select your role for the Provider Course:(Required)SelectPeerFamily memberClinician/mental health professionalThis field is hidden when viewing the formWhich class would you like to take?SelectWaitlist for Fall 2023 classesAre you a family member or close friend of an individual with a mental health condition?(Required) Yes No Not sure/Don’t know What is your loved one's mental health diagnosis?(Required)What is your relationship to this person?(Required)Does this person live with you? If not, how far away do they live?(Required)Have you attended a Family Support Group meeting before?(Required) Yes No Have you attended a Connection Recovery Support Group meeting before?(Required) Yes No Have you completed a Family-to-Family class before?(Required) Yes No This field is hidden when viewing the formAre you a veteran/service member? Yes No This field is hidden when viewing the formAre you a loved one of a veteran/service member? Yes No This field is hidden when viewing the formWhich course would you like to take?SelectSchedule date(s) and location(s)Waitlist for future classesThis field is hidden when viewing the formWhat do you hope to gain from this class?This field is hidden when viewing the formWhat do you hope to gain from this course?This field is hidden when viewing the formHow would you like to be involved with NAMI Vermont?This field is hidden when viewing the formMembership type:SelectIndividual ($40 for yearly membership)Household ($60 for yearly membership)Open Door ($5 for yearly membership for those with limited financial resources)This field is hidden when viewing the formNames of household members:This field is hidden when viewing the formTell us about yourself and your mental health journey. (optional)This field is hidden when viewing the formHow old are you? (optional)This field is hidden when viewing the formWill you need any special accommodations? If so, please state them.This field is hidden when viewing the formIs there anything else you’d like us to know?Will you need any special accommodations? If so, please state them.Is there anything else you'd like us to know?How did you find out about NAMI Vermont?I would like to receive the NAMI Vermont e-newsletter. Yes
