Become a Peer Mentor – TheNANProject

Become a Peer Mentor: Are you a young person who has experienced the effects of depression or suicidality and would like to share your story with others?

Please fill in all the information below:

Peer Mentor Form

Name*
First Name Last Name
Age*
Email Address*
Enter Email Address Confirm Email Address
Phone Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Current status - Are you a student and/or employed? If so, where?*
What languages do you speak?
Why do you want to become a Peer Mentor? In what ways can you contribute to the growth, development and improvement of The Nan Project?*
Have you or anyone you know struggled with mental health challenges? Please explain.
What does recovery mean to you? (The NAN Project's Peer Mentors use their stories of recovery to educate and covey hope to students around overcoming mental health challenges.)
What supports and/or resources play an important role in supporting your recovery? How do you remain invested in your recovery today? (ex. 12 step meetings, groups, therapy, etc.) Please list all that apply.
What is your work or volunteer history? What are your other hobbies?
Do you have access to transportation?*
- I have a car
- I have access to public transportation
- I have a reliable ride
- Not at this time
Would you be willing to participate in Peer Mentor training?*
If accepted, which training would you like to participate in? (Location or start date)
How did you hear about The NAN Project?*
Name
This field is for validation purposes and should be left unchanged.

Suicide Prevention Lifeline
1-800-273-TALK (8255)
www.suicidepreventionlifeline.org

For the Crisis Text Line, text "Listen" to 741-741

For the Samaritans, Call or Text (877)870-4673

For immediate crisis evaluation call the Emergency Services Program / Mobile Crisis Intervention at 1-877-382-1609 & enter your zip code; you will get the phone number of the closest ESP/MCI that serves you.

If you are in immediate danger, please call 911

Peer Mentor Form

If you need help and want to talk to someone, call: