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?

We will list information for any upcoming trainings here (none planned at this time)...

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
What Languages do you speak ?*
Current status - Are you a student and/or employed? If so, where?*
Why do you want to become a Peer Mentor?*
Have you or anyone you know struggled with mental health challenges? Please explain.
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?*

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: