Youth Advisory Council Member Application YAC Community Partners YAC Support Group Leaders Youth Advisory Council Member Application You may fill out the form below or download a form here. In order to apply to be a member, you must be between the ages of 18-28. Please provide your age below.*Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Alternate Phone NumberEmail Address* Enter Email Confirm Email Best time to call:*Are you currently a NAMI Mississippi member?*YesNoWhat is your NAMI Mississippi Affiliate?Central MississippiMeridianVicksburgYazoo CityFour Rivers (MS)OxfordPine BeltGulf CoastDo you have your own transportation?*YesNoDo you have access to public transportation?*YesNoAre you comfortable with self-disclosure?*YesNoList 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