Champions Application Form

The Champions Programme is targeted towards health and social care professionals working and supporting older people. Through the LGBT Champions Training Programme attendees will developing the awareness, confidence, competence and commitment, so they can transform the care experience of older LGBT+ people to one of inclusion, respect and dignity.

Through out Autumn 2020 LGBT Ireland will run three online LGBT Champions Training Events for health and social care professionals working in CHO Area 5.

The training events will take place through Zoom from 2:00pm - 5:00pm with a limit of 10 people per session. Training events will take place on the following dates:

September, Thursday 17th
September, Tuesday 22nd
September, Wednesday 30th

To Apply for one of these dates please complete this application form.

Please note:

Allocation of a place on any of the LGBT Champions Training events will be dependant on suitability of candidate and completion of this application for.

The above mentioned dates are only available to Health and Social Care professionals working in the CHO 5 area, for information on LGBT Champions Training opportunities outside of CHO 5 please contact the LGBT Champions Programme Coordinator James O'Hagan (james@lgbt.ie)

Section 1: General Information

Full Name

First Name Middle Name Last Name

Address

Street Address

Street Address Line 2

City County

Eircode Country

E-mail

example@example.com

Mobile Number

Which Date do you wish to apply for

***Allocation of a place on any of the LGBT Champions Training events will be dependant on suitability of candidate and completion of this application form.***

Where do you work within CHO Area 5

***The above mentioned dates are only available to Health and Social Care professionals working in the CHO 5 area, for information on LGBT Champions Training opportunities outside of CHO 5 please contact the LGBT Champions Programme Coordinator James O'Hagan (james@lgbt.ie)***

Section 2: About You

To help us understand the variety of practice settings and areas represented at the LGBT Champions Training event, please outline how you interact with older people as part of your current role.

Why do you wish to train to be an LGBT Champion?

How did you hear about the LGBT Champions Programme?

Section 3: Pre-Training Self-Assessment Survey

What percentage of the population do you think is LGBT+?

Are you aware of any specific LGBT+ inclusion measures within the service that you work?

Have you undertaken LGBT+ focused training previously?

How would you rate your awareness of issues facing older LGBT+people accessing healthcare?

No Awareness Slight Awareness Moderate Awareness High Awareness

How confident do you feel to meet the needs of an older LGBT+ person in your service?

No Confidence Slight Confidence Moderate Confidence High Confidence

LGBT CHAMPIONS PROGRAMME