Family-to-Family Test Family-to-Family Application - July 2020 Thank you for your interest in this 8-session course. The next class will begin Monday, July 27, 2020, from 3:30 to 5:30 pm and continue through September 21, 2020. The class will not meet Monday, September 7th. Please complete one application per person; kindly print! We will reach confirm your registration in advance and to answer questions about the program. There is no cost to participate, but because each class builds on the information shared in a previous class, we ask that you plan on making a regular commitment to attend. If at any time you need to miss a session or change your mind about participating, please let us know by calling the Warmline (866-960-6264). You may return this application: By mail, to: NAMI Sonoma County, 182 Farmers Lane #202, Santa Rosa CA 95405 or By email, to: firstname.lastname@example.org About YouName* First Last Phone*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country I would like to attend the class with:If you are attending with someone else, do they have the same contact information as you?If you answer "no," they will need to complete a separate application.YesNoN/AAbout Your Loved OneWhat is your relationship to the individual with a mental health condition?*I am their:ParentChildSiblingPartnerOtherWhat is your loved one's diagnosis (if known)?*Please check multiple boxes if necessary. Anxiety disorder Attention-deficit/hyperactivity disorder (ADHD) Bipolar disorder Borderline personality disorder Depression Dissociative disorder Eating disorder Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder (PTSD) Psychosis Schizoaffective disorder Schizophrenia Substance use disorder Unknown Other(s) not listed What is your loved one's current age?*At what age did your loved one's symptoms first appear?*At what age was a diagnosis first made?If no formal diagnosis has been made, skip this question.Is your loved one currently in treatment?*YesNoIs your loved one currently refusing treatment?*YesNoHow did you hear about the Family-to-Family class?Friend/FamilyMental Health AgencyMental Health ProviderNAMI Support GroupSocial MediaWeb SearchOtherMy loved one is a client of:Please select all that apply. Sonoma County Behavioral Health Kaiser Permanente Mental Health Services Private Provider (Psychiatrist, Psychologist, Psychiatric Nurse Practictioner) None of the above Other Do you have any comments, questions, or concerns?