Name:

Family-to-Family Teacher Requirements

By completing this application, you are acknowledging that you understand and agree to the following requirements.

To be a successful NAMI Family-to-Family teacher, you need to respond to others in a non-judgmental way, you need to be a good listener with an empathetic ear, and you need to be willing to talk about your experience as a family member of someone living with a mental illness.

Participation in this training does not guarantee that you will become a certified NAMI teacher.

Trainees must demonstrate the qualifications needed to become a good NAMI teacher by the end of training. Trainees may be asked to improve their skills in particular key areas and repeat the training before they may become certified.

F2F Teacher Requirements:  Be a first-degree relative of an individual living with mental illness or have lived in a household for a significant period of time with a family member living with a mental illness.  Arrive at the training on time and complete all three days of training (Fri 9:30 am – 8 pm, Sat 8 am – 7:30 pm, Sun 8 am – 1 pm).  Adhere to Family-to-Family program policies and teach the class as prescribed by NAMI National and the approved curriculum.  Begin teaching a Family-to-Family education class within 1 year of training.  Teach two Family-to-Family classes over the next 2 years.  Communicate with NAMI Oregon state office as requested.  Provide participant data following each class.  Identify potential new teachers from your classes.  Encourage class participants to become NAMI members.  Have a positive regard for, or personal experience with, mutual support.  Authorize a criminal background check.

Please check box to indicate that you have read and understand the above requirements.

Family-to-Family Teacher Training Application 4701 SE 24th Ave., Suite E, Portland, OR 97202 503-230-8009 Rev. Apr. 2017 Family-to-Family Teacher Training Application August 3-5, 2018 Providence Willamette Falls Medical Center 1500 Division St. Oregon City, OR, 97045

Applications due by: Friday July 20, 2018 • Please include a letter of reference from an F2F teacher and/or a NAMI affiliate leader. • Applicant must be a current NAMI member or join NAMI by the application due date. • A phone interview will be conducted.

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Name:

Home Address:

City/State/Zip:

Home Phone:

Cell Phone:

Email:

NAMI Member? Yes: No: My NAMI affiliate is (check one):

Central Oregon Clackamas County Clatsop County Columbia County

Coos County Douglas County Klamath County Lane County Marion/Polk Counties Mid-Valley/Benton County Multnomah County Southern Oregon

Washington County Yamhill County Clark County, WA Other Participant Survey

Are you a family member of an individual who has a mental illness? Yes No

Note: You must be a first-degree relative to be a Family-to-Family teacher or have lived in a household with a relative with mental illness for a significant period of time.

Your ill relative is your (spouse, sister, etc.):

Your relative’s diagnosis is:

You plan to teach: the 12 week Family-to-Family course the 4-hour Family & Friends seminar: both

Family-to-Family Teacher Training Application 4701 SE 24th Ave., Suite E, Portland, OR 97202 503-230-8009 Rev. Apr. 2017 Have you ever been convicted of a felony? Yes No If yes, please explain.

Have you completed the Family-to-Family class? Yes No

Have you taken other NAMI classes or trainings? Please list below.

Please briefly describe your experience with your relative who lives with mental illness:

Please explain why you want to become a NAMI Family-to-Family teacher:

Family-to-Family Teacher Training Application 4701 SE 24th Ave., Suite E, Portland, OR 97202 503-230-8009 Rev. Apr. 2017 Lodging and Other Needs Do you require a handicapped-accessible training facility? Yes No

Do you require lodging for the training? Yes No

Do you require a handicapped-accessible hotel room? Yes No

Are you willing to share a room* (if hotel accommodations are offered)? Yes No

Gender (used only for lodging arrangements): Male Female Neither

If hotel offered, you would like to share with:

*For trainees travelling 50 miles or farther, NAMI Oregon will arrange and pay for double-occupancy lodging near the training site. Trainees requiring private rooms will need to arrange and pay for their own lodging. If you accept lodging offered by NAMI Oregon but must withdraw from the training before it begins, you must contact NAMI Oregon ASAP so the lodging reservation can be canceled without paying a penalty.

Please list any special needs for accommodations or meals, including food or other allergies**:

**Some meals, snacks, and beverages are provided throughout the training. Consult the training schedule to see which meals are provided. When possible, NAMI Oregon will accommodate dietary restrictions. Trainees with extensive dietary restrictions should plan to supplement the food provided by bringing items from home.

Return Applications and Letters of Reference to:

Peter Link NAMI Oregon 4701 SE 24th Ave., Suite E Portland, OR 97202 Fax: 503-230-2751 Email: [email protected]

Family-to-Family Teacher Training Application 4701 SE 24th Ave., Suite E, Portland, OR 97202 503-230-8009 Rev. Apr. 2017