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Illinois NAMI Young Mental Health Leaders 2023 Workgroup Registration
Contact Information
Name
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First Name
Last Name
What is your age?
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Phone
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Email
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Verify Email
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Address
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Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
2023 Workgroup Registration
Did you attend one or both of the kickoff and informational meetings in December 2022?
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Please Note: Attendance at one of these meetings is not required to be part of the 2023 workgroup, if you wish to become a member.
Yes
No
Are you already involved with NAMI Illinois, a local NAMI affiliate, a youth organization, or a structured program??
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Please note: You do not need to be affiliated with NAMI, a youth organization, or a structured program to be part of the workgroup.
Yes
No
If yes, please list what NAMI affiliate, youth organization, or structured program are you already involved with?
What key takeaways do you have from the kickoff and informational meeting(s)?
Do you want to be a member of the 2023 workgroup?
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If yes, we will send out meeting invites and put you on our workgroup distribution list. Please note: A program agreement will need to be signed (including guardian signature, if applicable) and submitted by the first workgroup meeting on January 18th. You will be emailed the program agreement after submitting registration for the workgroup.
Yes
No
How did you find out about the workgroup?
What are you looking forward to the most with the workgroup?
What are things you would like to see come from the 2023 workgroup?
Do you have any suggestions that can help shape the workgroup's efforts in 2023?