Volunteer Application

Participant Info
First Name*
Middle Initial
Last Name*
Address
City
State
Country
Email*
Are you able to work weekly or monthly?*
How many hours can you work per week/month?*
When can you start?*
Would you prefer to volunteer a regular schedule or as needed?*
Why do you want to volunteer for us? Do you have a connection to mental illness?*
What skills would you bring to the volunteer position?*
Do you speak any additional languages? If so, please indicate degree of fluency.
Age
Gender
Marital Status
Number of Children
Veteran?
Culture	African-American Anglo Native American Latino/Hispanic Asian-American Other
If Other is selected above, please indicate your ethnicity:
VOLUNTEER OPPORTUNITIES Check all areas of interest below:
OUTREACH:	Facilitate a Program Info Table Newsletter FACILITATE A NAMI OUTREACH PROGRAM: Facilitate an outreach program such as Parents and Teachers as Allies, Faith Community Outreach, or In Our Own Voice; 2-4 times a year for 1 1⁄2 hours to 3 hours at a local church, school or community center. Must attend facilitator training and be a caregiver or an individual diagnosed with mental illness. Time involved: 1-3 hours each presentation. INFORMATION TABLES: Set up and take down a table with NAMI information for NAMI in the Lobby at hospitals, health fairs and community outreach fairs in local libraries, parks, hospitals, business, etc. Time involved: 1-4 hours per fair (weekends available). NEWSLETTER: Review books, write articles, find articles, summarize legislation, notice events, etc. to submit for consideration for the quarterly newsletter and monthly e-news. Time involved: varies
VOLUNTEER FOR A COMMITTEE: If interested, NAMI Mississippi members may be invited to join working Committees, including:	Media & Marketing Programs Development Public Policy & Advocacy NAMIWalks Strategic Planning Finance Volunteers Nominating Speakers Bureau
NAMIWALKS: Assist in the tasks involved in the year-round organization of the annual NAMIWalks event held in the fall, such as:	Join the Walk Committee or a Subcommittee Assist with the Kick-off Luncheon in the fall Assist with the sponsorship or in-kind donations Be a Walk Day Volunteer
EMERGENCY CONTACT INFORMATION
Relationship:*
In case of emergency contact:*
Home Phone:*
Work Phone:*
Mobile Phone:*
Address*
City*
State / Province / Region*
ZIP / Postal Code*
Country
Allergies*
Medications*
Medical Conditions*
Anything else we should know?
VOLUNTEER RELEASE FORM By completing and submitting this form, you are indicating the following: I hereby release, indemnify, and hold harmless NAMI Mississippi, the Organizers, Sponsors, and Supervisors of all activities from any and all liability in connection with any injury (including any injury caused by negligence), in conjunction with volunteering for NAMI Mississippi. I likewise hold harmless from liability any person transporting me to and from any agency activity. In addition, the agency has permission to utilize for publicity purposes any photographs or videos taken.
Check this box to acknowledge that you agree with the above statement.*	I agree with the above statement.
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OUTREACH:

Facilitate a Program Info Table Newsletter

FACILITATE A NAMI OUTREACH PROGRAM: Facilitate an outreach program such as Parents and Teachers as Allies, Faith Community Outreach, or In Our Own Voice; 2-4 times a year for 1 1⁄2 hours to 3 hours at a local church, school or community center. Must attend facilitator training and be a caregiver or an individual diagnosed with mental illness. Time involved: 1-3 hours each presentation.

INFORMATION TABLES: Set up and take down a table with NAMI information for NAMI in the Lobby at hospitals, health fairs and community outreach fairs in local libraries, parks, hospitals, business, etc. Time involved: 1-4 hours per fair (weekends available).

NEWSLETTER: Review books, write articles, find articles, summarize legislation, notice events, etc. to submit for consideration for the quarterly newsletter and monthly e-news. Time involved: varies

VOLUNTEER FOR A COMMITTEE: If interested, NAMI Mississippi members may be invited to join working Committees, including:

NAMIWALKS: Assist in the tasks involved in the year-round organization of the annual NAMIWalks event held in the fall, such as:

Join the Walk Committee or a Subcommittee Assist with the Kick-off Luncheon in the fall Assist with the sponsorship or in-kind donations Be a Walk Day Volunteer

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Volunteer Application

Participant Info

VOLUNTEER OPPORTUNITIES

EMERGENCY CONTACT INFORMATION

VOLUNTEER RELEASE FORM

Become a Member

Get Involved

Get In Touch