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NAMI Homefront Registration
Thank you for showing interest in our NAMI Homefront program. Once you fill out the form below, a NAMI staff member will be reaching out to you via phone to complete a pre-screening questionnaire to make sure this training is the best fit for you. If you have any questions, please email us at education@namimch.org
DateTime
*
Your name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
NAMI has my permission to leave voice mails at this phone number
NAMI has my permission to send text messages to this phone number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your date of birth:
*
-
Month
-
Day
Year
Date
Email address. We WILL send you communication and resources via email. Please ensure that you are providing an email address that you do have access to and that you check regularly, including your spam folder.
*
example@example.com
Confirm email address
*
example@example.com
Are you a family member, caregiver, and/or close friend of a Military Service Member/Veteran living with a mental health condition?
*
Yes
No
Are you or your loved one in crisis currently?
*
Yes
No
Are you able to commit to 7 weeks?
*
Yes
No
Do you have access to the internet?
*
Yes
No
Do you have access to a printer?
*
Yes
No
Do you have access to a device that can access Zoom?
*
Yes
No
Best time to contact you.
Days:
blanks
. Hours:
blank
Submit
Should be Empty: