Volunteer Onboarding Application
First Name *
Last Name *
Address 1 *
Address 2
City *
State/Province *
Alabama
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District of Columbia
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Texas
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Washington
West Virginia
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American Samoa
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U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip *
Phone *
Phone Type *
Home
Mobile
Other
Work
Email *
How many hours a week or month do you wish to contribute? *
When are you available to start? *
Would you prefer to volunteer on a regular schedule or as needed? *
Regular schedule As needed
Why do you want to volunteer for NAMI?
Do you speak any additional languages? If so, please indicate the language and level of fluency.
Opportunities
It is helpful to be aware of our programs before indicating which one(s) in which you are interested. Please OPEN ANOTHER WINDOW and copy and paste https://namisouthernnevada.org/programs/ to see our programs. DO NOT CLICK THE LINK IN THIS WINDOW AS YOU MIGHT LOSE YOUR INFORMATION.
Select up to FIVE activities or programs you are interested in:
Education Classes
NAMI Basics NAMI Family-to-Family NAMI Homefront NAMI Peer-to-Peer
Presentations
NAMI Ending the Silence NAMI Family & Friends NAMI In Our Own Voice NAMI Sharing Your Story with Law Enforcement
Support Groups
NAMI Connections Recovery (Peer) Support Group NAMI Family Support Group
Outreach & Advocacy
Community Representative NAMI FaithNet NAMI On Campus NAMI Smarts for Advocacy Outreach Social Media
Other
Hearing Voices Experiential Workshop NAMI HelpLine Office (Administrative and Clerical) Resource Team Special Events Special Populations Stress Management Workshops
Select the up to TWO NAMI National program(s) in which you are interested in helping us start:
Crisis Intervention Team (CIT) Program NAMI Compartiendo Esperanza NAMI Provider Education NAMI Sharing Hope NAMI Walks
Select any opportunities in which you would like to volunteer for:
Advocacy Community and resources researcher Flyers/brochures carrier Information and referral specialist Information tables Initiate/organize outreach Newsletter
Select any special populations related to mental health in which you would like to engage:
College students Faith communities Individuals who are homeless Individuals with addiction/substance abuse Individuals with experiences of physical abuse Individuals with past records of crime Law Enforcement LGBTQ+ community Mental health professionals Veterans Youth
Select all NAMI committees/projects you are interested in helping:
Finance Development and Membership Education Volunteers Public Policy and Advocacy Strategic Planning Speakers Bureau Media and Marketing Community Networking and Resources
Select all special events you are interested in pursuing as a volunteer and/or organizer:
Mental Health Awareness Month (May) Minority Mental Health Awareness Month (July) National Recovery Month (September) Suicide Prevention Month (September) Mental Illness Awareness Week (first week of October) NAMI Conference
Are you a high school or college student?
High school College N/A
Are you a student looking for a school internship?
Yes No
Background and Demographics
The information below is OPTIONAL. Please feel free to share information in which you are comfortable sharing.
Which category below includes your age?
17 or younger 18-20 21-29 30-39 40-49 50-59 60 or older Prefer not to answer
What is your ethnicity?
American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Hispanic or Latino or Spanish Origin Multiple ethnicities Other Prefer not to answer
What is your marital status?
Married Widowed Divorced Separated Never married Prefer not to answer
Do you have any children? How many?
Are you a veteran?
Yes No Prefer not to answer
What is the highest level of school you have completed or the highest degree you have received?
Less than high school degree High school degree or equivalent (e.g., GED) Some college but no degree Associate degree Bachelor degree Graduate degree Other Prefer not to answer
Do you have professional experience in the mental health field? What is your professional background and/or career choice?
What is you current or past work experience that you feel comfortable sharing?
Do you have personal experience with mental illness (i.e., self, loved one, etc.)? If you are comfortable, please briefly share.
Do you identify with any of these mental health related experiences?
I am/have been diagnosed with a mental illness. I am/have been addicted to a substance. I am a suicide attempt survivor. I lost a loved one due to suicide. I have a loved one who attempted suicide. I know a family member or loved one who is/has been diagnosed with a mental illness. I am/have been homeless due to a mental health condition/symptoms. I have a past record of crime/current legal situation due to a mental health condition/symptoms. Prefer not to answer
Select if you have one or more of the following diagnoses.
Major Depressive Disorder Bipolar Disorder Schizophrenia Schizoaffective Disorder Eating Disorder Anxiety Disorder Obsessive Compulsive Disorder (OCD) Borderline Personality Disorder (BPD) Attention-Deficit (Hyperactive) Disorder (ADD/ADHD) Post-Traumatic Stress Disorder (PTSD) Psychosis Autism Spectrum Panic Attack Other Prefer not to answer
Signature
I certify that all information on this application and on any other forms I complete during the application process is true and correct to the best of my knowledge. I understand that if I have provided false information or misrepresented myself, this is sufficient cause for not being accepted as a volunteer.
Signature *
Date *
Permission for Treatment of Application
I understand that every attempt is made to ensure the safety of persons volunteering with NAMI Southern Nevada. When illness or an accident occurs either at an agency transportation to a program activity, we will contact the volunteer’s designated emergency contact as soon as possible, There may be times when the designated person cannot be reached soon enough to meet the immediate need. In the event of an accident or illness requiring emergency medical treatment by a physician or hospital, I hereby authorize the Executive Director (or designee) of NAMI Southern Nevada to secure necessary treatment on my behalf. I further agree to assume financial responsibility for such emergency medical treatment not covered by Workman’s Compensation Insurance.
In case of emergency, contact: *
Relationship *
Phone of Contact *
Address of Contact *
City, State, Zip *
Important medical information (allergies, medication, medical conditions, etc.) *
Volunteer Signature *
Date *
Volunteer Release Form
I hereby release, indemnify, and hold harmless NAMI Southern Nevada, the organizer, 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 Southern Nevada. 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.
If the individual is a minor (under 18 years of age), a parent or legal guardian should sign the following: I hereby consent and agree, individually and as a parent or legal guardian of (name of child).
Name/Signature *
Relationship (If acting on behalf of a minor) *
Date *
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