Volunteer Application Complete the form below. (For best results, use Google Chrome.) Or click here to download the PDF. Minor applicants (under 18 years of age) must submit a paper application. Participant Info First Name* Middle Initial Last Name* Address City State Country Email* Are you able to work weekly or monthly?* Weekly 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?* Regular Schedule 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 Single Married Divorced Widowed Separated Living With Partner Number of Children Veteran? Yes No 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. Confirm your humanity.* 3 − 1 = ? Forget your private link? Click here to have it emailed to you.