NEW of 2024 Helpline Communication Survey (Internal)

This is Me Program Interest Form

We offer a 6-Week Youth Program 'This Is Me' that uses wellness, art, games, education and more to open a safe space to talk about mental health and help youth gain a better understanding of themselves. This program is led by trained peers in recovery. Programming can be done on-site or at our NAMI office location.
Name:*

First NameLast Name
Organization
example@example.com
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Ideal Start Date

MonthDayYear
Ideal Days for Programming

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Ideal Times for Programming

MorningAfternoonEvening
Location

On-SiteNAMI LocationOther
Done!

Please press submit
Should be Empty:

This is Me Program Interest Form