Peer Connector Participant Application


    PLEASE NOTE ALL ANSWERS WILL BE HELD IN STRICT CONFIDENCE.
    Only a person with a mental health condition may request a Peer Connector. NAMI Community Peer Program does not accept referrals to the program from family, friends, or mental health professionals.

























    Emergency Contact







    The following questions will help us know you better in order to make the best match possible





    List three (3) goals you would like to achieve while working with your Peer Connector?