Board Application

Would you like to be a member of the NAMI Wilmington Board?

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
County*
Phone*
Email:*
What role do you play in the mental health community?
- Peer
- Caretaker
- Professional
- Family Member
- Friend
Please indicate your current familiarity with NAMI*
Which NAMI-Wilmington activity would you be interested in participating in:*
Briefly describe/provide examples of your general background experiences and indicate how these could benefit the organization.*
Briefly describe/provide examples of your experineces related to mental health issues and how these can benefit NAMI Wilmington:*
Prior experience with non profit organizations and/or boards?*
Experience in non-profit support business?*
Specialized knowledge of one or more NAMI or other recovery program areas?*
Other specialized training or expertise?*
Signature*
Date of Birth: (a DOB is necessary to perform background check. Certain offenses, i.e sexual offenses, would prohibit an individual from serving on the board member).*
Date Format: MM slash DD slash YYYY