NAMI on Campus Contact Form

A NAMI on Campus club at your college or university is a joint collaboration between the club, the NAMI State Organization (NSO) and the NAMI Affiliate (NA) in your area, if one is available. The contact information below is required by NAMI after the student club application has been accepted by their college.

NAMI on Campus Club Information

(Please type "N/A" into any fields that don't apply)

School Name*

Today's Date*

Primary Contact (Student)*

Primary Contact Phone*

Primary Contact Email*

Secondary Contact (Student), if applicable*

Secondary Contact Phone, if applicable*

Secondary Contact Email, if applicable*

Faculty Advisor, if applicable*

Faculty Advisor Phone, if applicable*

Faculty Advisor Email, if applicable*

NAMI would like to list your name and email in a directory that campus clubs can use to communicate with one another. Please select the option below that indicates your preference on sharing your contact information.

Willing to share contact information?*

Select

NAMI Affiliate (NA) Information

(Please type "N/A" into any fields that don't apply)

NAMI Affiliate (NA) Name*

Name of NA Contact Person for NAMI on Campus*

NA Contact Phone*

NA Contact Email*

NAMI State Organization (NSO) Information

(Please type "N/A" into any fields that don't apply)

NAMI State Organization (NSO) Name*

Name of NSO Contact Person for NAMI on Campus*

NSO Contact Phone*

NSO Contact Email*

NAMI will use this information to communicate important updates and opportunities that address the needs of young adults and campus mental health. It's important for the NSO/NA to keep the campus club contact information current for NAMI.

Club leaders, the NAMI State Organization and NAMI Affiliate (if applicable) are all aware of this NAMI on Campus Contact Form being submitted.

If you need to make a correction to your form, please email us at namioncampus@nami.org instead of submitting a new form.

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