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?

Upcoming trainings:

At YouForward in Lawrence:
Tuesday, September 3
Thursday, September 5
Tuesday, September 10 and
Thursday, September 12.
See the Lawrence flyer here!

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?*
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: