Children and Young People and Parent/Carer Advisory Board Application form
First Name:
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Surname:
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Home Address:
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Telephone No: (Day):
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Telephone No: (Evening):
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Email Address:
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Please tick which role are you applying for:
Please tell us about why you have applied for this role and your experience with mental health?
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Previous experience relevant to this role? (Paid or Unpaid)
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What do you hope the Advisory Board will be able to achieve?
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Any other information relevant to the post:
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Do you have additional support needs? (Please specify)
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How did you hear about the Advisory Board role?
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Agreement
Please sign to confirm that the details contained in this form are a true reflection of the discussion
Signed:
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Date:
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