AMIAS Certification Form

New AMIAS (Al-Anon Member Involved in Alateen Service) Application Form

You must be an Alanon member living in the Southern California World Service Area (see area map) to complete this form.

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APPLICANT INSTRUCTIONS

You must reside and attend Al-Anon meetings in the Southern California World Service Area (see area map) to complete this form.

I reside in the Southern California World Service Area. *

I attended AMIAS Certification training (enter date and location) *

Name *

First

Last

Email *

Home World and

Primary Phone *

Address *

Address Line 1

City

State

Zip Code

I meet all SCWS Eligibility Requirements for AMIAS certification. I check each line item below as a true statement.

*

Home Meeting Location and City *

Home Meeting Day and Time *

Acceptance Criteria for AMIAS *

I am at least 25 years of age
I have at least two consecutive years in Al-Anon in addition to any time spent in Alateen
I have not been convicted of a felony
I have not been charged with child abuse or inappropriate sexual behavior
I have not demonstrated emotional problems which could result in harm to Alateen members
I am willing to step down immediately if there is a controversy that interferes with the purpose of serving Alateen members
I am in compliance with and agree to abide by the SCWS Area Alateen Safety and Behavioral Requirements

I am willing to share my email address and phone number with other AMIAS. My preferred means of contact is: