NAMI California Peer-To-Peer Mentor Training Application

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NAMI California Peer-to-Peer Mentor Training Application

Date of the training: ______City where training will be held: ______

Applicant Information:

Best time to call:

What language(s) other than English do you speak fluently? ______

Reference (Name/Email or Phone):______

(Please note: Your reference should be someone who knows you well enough to recommend that you be trained to become a Mentor.)

1. Have you ever been convicted of a felony? ☐Yes ☐No

If yes, please explain: ______

1. Have you taken the Peer-to-Peer 10 week course? ☐Yes ☐No If no, please explain why: ______

Trainingsbegin at9:00 a.m. Fridayand end at 6 p.m. Sunday. The training site address is provided in the confirmation letter.

1. I will be able to attend the entire training. ☐Yes ☐No

1. I will be available to teach a Peer to Peer Course within the next 6 months. ☐Yes ☐No

1. NAMI Education Program classes require reading the curriculum aloud.Do you consider yourself to be a good reader? ☐Yes ☐No If no, please explain:______
2. Who recommended you for this training?(Name)______

1. What is his/her involvement with NAMI?______

(Peer Mentor, Support Group Facilitator, NAMI Board Member or other volunteer, etc.)

1. What is his/her email/phone? (Required): ______

NAMI California Peer-to-Peer Mentor TrainingApplication

1) How do you define recovery? How are you doing in recovery right now? Please explain:

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2) Do you feel you can offer support in the manner that you have been supported? Please explain:

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3) Do you feel you have come to terms with your mental illness? Please explain: ______

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4) Are you comfortable talking about your experiences as a person living with mental illness and what you have learned? Please explain: ______

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5) If you have taken the Peer to Peer course what did you like/dislike about it? Do you see the importance of adhering to the curriculum? Please explain: ______

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Availability to co-mentor NAMI Peer-to-Peer courses (Check all that apply):

TRANSPORTATION TO PEER-TO-PEER CLASSES:

Do you have your own transportation? ☐Yes ☐No

Do you have access to Public Transportation?☐Yes ☐No

Are you willing to travel? ☐Yes ☐No

• If yes, how far:☐5-10 miles ☐11-20 miles ☐More than 20 miles

IF YOU ARE SELECTED TO ATTEND THE TRAINING:

Transportation to Peer-to-Peer Training:

Do you have transportation to this training? ☐Yes ☐No

• If yes, would you be willing to transport other participants?☐Yes ☐No

• If yes, initial to allow sharing of your personal contact information for carpooling reasons only.

Initials: ______

• If no, are you requesting to carpool with another participant? (Requests to be made no later than 2 weeks before a training.) ☐Yes ☐No

Commuting:

If I live within 30 minutes of the training site,I intend to drive to and from home each day. ☐Yes ☐No If you intend to commute each day, will you be staying for the dinner meals? ☐Yes ☐No

Thursday Night Stay:NAMI CALIFORNIA DOES NOT COVER Thursday night stays

I will check with my affiliate to see if they will cover my Thursday night stay should I need to arrive the day before ☐Yes ☐No

Do you need any special accommodations that we should be aware of? ☐Yes ☐No

If yes, please specify: ______

Do you have any dietary considerations or food allergies? ☐Yes ☐No

If yes, please specify:______

NAMI California may not be able to accommodate all dietary requests. Options can be discussed upon acceptance into the training.

Emergency Information:

Contact Name:______Relationship to you: ______

Telephone numbers (2 preferred): ______

Do you have a cell phone number we can reach you at that weekend? ______

Job requirements

Willing and able to undergo an intensive three-day training

Agree to adhere to fidelity of the NAMI Peer-to-Peer model at all times

Make a commitment to teach at least two classes within two years of training

Agree to report class data

Willing to identify potential new participants

Is or become a member of NAMI

Comfortable reading aloud to the group

Participates in an active treatment plan

Attitude of sincere, uncritical acceptance of students and co-mentors

MENTOR AGREEMENT

• I agree to be at each session of the Peer-to-Peer workshop on time. Please understand that if you are excessively late to sessions or leave more than 30 minutes early on Sunday you may jeopardize your participation in the workshop and a teacher certificate may not be issued to you.

• I understand that participation in this training does not guarantee that I will become a certified NAMI Mentor. Trainees must demonstrate the qualifications needed to become a good NAMI Mentor by the end of the training. The first day of training provides an opportunity for trainees to assess their basic qualifications for being a teacher. Any concerns should be brought to the trainers’ attention. Attendance at a training does not guarantee teacher certification.

• I agree to behave in a professional manner. To be described as not engaging in illegal drug use, or to be sexually or romantically intimate with participants at the training unless I am have been in a committed relationship with that person prior to the training. This also includes not behaving in a way that is disrespectful, violent or aggressive.

• I agree to notify Lynn Cathy at (916) 567-0163, if I must cancel.Prompt notification of a cancellation enables us to invite another participant if one is available. NAMI California must still pay for lodging and catering arrangements on cancellations made within 3 days of a training, so it is important for you to notify us as soon as possible.

• I agree to teach (2) 10-week sessions of Peer-to-Peer within two years.It is understood that unexpected situations may occur in which flexibility in this policy will be needed.

• I agree to teach Peer-to-Peer according to the established NAMI Operating Policies.

☐I have read, understand and agree to the NAMI California Peer-to-Peer Mentor job requirements.

______(initial)

☐I understand that my attendance at Mentor Training does not guarantee that I will be certified as a NAMI California Peer-to-Peer Mentor. ______(initial)

By attending the NAMI California Peer-to-Peer Mentor Training, and receiving certification as a mentor, I acknowledge that I am making a commitment to leading at least two Peer-to-Peer courses.

______

Signature of Applicant Print Name Date

*Please follow up faxed applications with a phone call or email to confirm receipt.

All applications must be received at least 5 weeks before the beginning date of the training. Please remit as soon as possible as trainings fill quickly. Thank you! Applications received after that time will only be reviewed if class space is still available.

YOU WILL BE NOTIFIED BY EMAIL IF YOU HAVE BEEN SELECTED TO ATTEND.

ABOUT PEER-TO-PEER

• NAMI Peer-to-Peer is a free, 10 session class to help adults living with mental health challenges achieve and maintain wellness.
• Information is included on conditions such as major depression, bipolar disorder, anxiety disorders, schizophrenia, and borderline personality disorder, among others.
• Participants leave NAMI Peer-to-Peer with a customized relapse prevention plan and a form they can use to create their own Advance Directive for Mental Healthcare Decision Making.
• Discussion and interactive exercises focus on mindfulness and meditation, relapse prevention, and healthy coping skills to help deal with life’s challenges.
• Peer-to-Peer does not recommend or endorse any medications or other medical therapies.

DUTIES OF A PEER MENTOR:

• Co-teaching the class. Peer-to-Peer classes are led by two mentors.
• Report the class data on NAMI National’s website or the local affiliate for them to report. Mail teacher evaluations to the State Family and Peer Programs Coordinator. (Arrangements can be made for those without internet access.)
• Updating your mentor manual. Updatesare downloaded from the NAMI National websiteby your affiliate’s education coordinator. Updates can be expected in late December or early January and are announced via mass email (to the coordinators), in the NAMI California Weekly Report and on the NAMI California website. (You can sign up for the NAMI California Weekly Report by submitting a request to )
• Mentors may need to find a location to hold a class, advertise, register the participants, prepare materials to be handed out, collect class supplies – markers, charts, etc. In most cases your local affiliate has a volunteer coordinator who will set up the Peer-to-Peer class for you, all you will need to do is teach and report the class data.

Last Revised 1/14/16