NNED Member Registration Form

The NNED invites individuals and organizations addressing mental health or substance use disparities, with a strong focus on diverse communities, to join the NNED. Please complete this registration form to join. You will receive notification of your acceptance as a NNED Partner or Affiliate or a request for additional information within 2 business days.

Please Contact us if you need assistance. Form fields below with * are required.

Personal Info

 
 
 
 
 

Purpose for Registration


  My organization would like to become a NNED partner
  My organization is currently a NNED partner, and I'd like to sign up as an individual NNED affiliate
  I would like to become a NNED affiliate (individual membership)

About Your Organization

 
 
 
 

primary areas of focus

Select your organization's primary areas of focus:













Type of Organization & services



Administrative Services

If your organization type is Administrative, indicate the services your organization provides:









Direct Services

If your organization type is Direct Service, indicate the services your organization provides:













Population Of Focus

All Population Of Focus*

Select all that apply:









Primary Population Of Focus*

Population Of Focus Detail

Provide more detail about your population(s) of focus by writing in specific groups that your organization serves. This help us tailor our outreach, make specific requests for NNED involvement, and share resources. Please separate groups by commas.

For example, provide name(s) of tribes, specific ethnic groups (e.g., Filipino, Pakistani, Samoan, Haitian, Puerto Rican, Mexican American), refugee countries of origin, etc. The more detail the better!


Languages

Indicate the language(s) and language services your organization provides (other than English):






Geographical Community

Select the geographical community of your population of focus:





Age Range

Select the age ranges of your population of focus:







Outreach

Indicate all of the NNED services that would be useful for your organization:







A few more things...

For security purpose, please type the test word you see below:

 Enter test word* →

Thank you for your interest in the NNED! Access to secured areas of NNED web site will be granted after application approval. Your account will be activated within 48 hours and you will be notified by email.