A 6-Week Course for Parents and Other Primary Caregivers of Children and Adolescents Living

A 6-week course for parents and other primary caregivers of children and adolescents living with serious behavioral issues or early onset of a mental health condition.

In order to be eligible for this program you must meet all of the following requirements. Please read and check each box below:

 I am a parent or primary caregiver of a child or teen who exhibited symptoms of a mental illness prior to age 13.

 I can commit to teaching two classes in the next two years. The time, energy and expense of training each teacher makes this a necessity. It is understood, that unexpected situations may occur that will necessitate compassion and flexibility in this policy.

 I like to teach as a team.

I have a welcoming personality and am interested in sharing information with families as they face the challenges of living with a mental illness.

I am a NAMI Austin member (or willing to become a member).

I agree to abide by NAMI policies and procedures.

I must make every attempt to fulfill my volunteer commitment as outlined in the training application.

I understand that participation in training does not guarantee certification. NAMI state-level trainers determine if an individual has met all criteria.

Submit this completed application directly to: Jessica Miller,

NAMI Austin Basics Teacher Application

1.Have you ever taken the NAMI BasicsCourse?

□Yes□No

If yes, give teacher’s name, location of class and date: ______

If no, have you ever taken any other NAMI educational courses (Family to Family, Peer to Peer)?

□Yes□No

If yes, give teacher’s name, location of class and date:______

2.Are you a member of NAMI? □ Yes □ No

If yes, list the affiliate you are associated with: ______

3.Are you a member or facilitator of a support group? □Yes □ No

If yes, where does your groupmeet? ______

4.Are you a parent or other direct caregiver of an individual who developed symptoms of mental illness before the age of13? □Yes □ No

5.What is the age of thatindividualnow? Years

6.Has he/she been givenadiagnosis? □Yes □ No

If yes, what is the most currentdiagnosis?______

7.How long has he/she exhibited symptoms ofmentalillness? Years

8.Does/did your child attendpublicschool? □ Yes □No

If no, what type of educational program is/was your child involvedin? ______

9.Has your child graduated from High School? □Yes □ No If so,when?______

10.Do you speak Spanish fluently? □ Yes □No

If so, are you interested in teaching NAMI Basics in Spanish? □ Yes □ No

11.How did you hear about us? ______

12. Do you need any special accommodations that we should be aware of? If so, please specify.

______

13. Availabilitytoteach(pleasecircle allthat apply): Please note that classes require either

weekday daytime, weekday evening or Saturday morning availability.

Weekday daytimeWeekday eveningSaturday morning

Please answer in a few sentences

14. Why you would like to become a NAMI BasicsTeacher?

15.Your experiences with a child or adolescent with mentalillnesses.

______

Signature of Teacher ApplicantDate

______

Signature of NAMI Austin Executive DirectorDate

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