Youth Advisory Council Member Application

In order to apply to be a member, you must be between the ages of 18-28. Please provide your age below.*

Name*

Prefix First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Alternate Phone Number

Email Address*

Enter Email Confirm Email

Best time to call:*

Are you currently a NAMI Mississippi member?*

What is your NAMI Mississippi Affiliate?

Do you have your own transportation?*

Do you have access to public transportation?*

Are you comfortable with self-disclosure?*

List other NAMI programs you have participated in, if any, and your role in the program (e.g. participant, facilitator, presenter, trainer, etc.).*

How did you learn about NAMI Mississippi?*

What would serving on the Youth Advisory Council mean to you?*

What would you like to focus working on if you were to serve on the Youth Advisory Council?*

Please share a little about your interest in volunteering with NAMI Mississippi.*

CAPTCHA

Menu