NAMI On Campus Interest Form Name First Last Pronouns:Email(Required) Phone(Required)I am a…(Required) High school student College student School faculty/staff member Other School/Organization Name:(Required)School Town/City:(Required)Do you have a faculty advisor who can reliably facilitate this club?(Required) Yes, I do No, I will lead this group I do not have a faculty advisor to lead this club Name of Advisor who will support this club:(Required) First Last Advisor’s Email:(Required) Advisor’s Phone Number:(Required)Advisor’s Title/Role:(Required)How did you find out about the NAMI On Campus program?(Required) Newspaper Mailing Healthcare Provider NAMI Vermont Website NAMI National Workplace Word of Mouth Poster Social Media Other I would like to receive the NAMI Vermont monthly e-newsletter. Yes
