IMPACT Networks Application Form

APPLY TO JOIN AN IMPACT NETWORK
IMPACT is a new UK centre that wants to make adult social care services better for people who use them.

DHCNI is co-ordinating two IMPACT networks in Northern Ireland.
If you live in Northern Ireland and you have lived experience of adult social care, you are invited to apply to join one of our IMPACT networks.

You can choose to apply one or both of our networks, to consider:
1. How technology can be used to help people be more independent or to prevent harm.
AND/OR
1. How to involve people lived experience of adult social care in strategic decision making.
Have your views heard and work towards change. Apply to join a network by completing the sections below:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
What is your experience of adult social care?

User of adult care servicesCarer (family member)Professional care providerCare home employeeHealthcare professionalCommissionerOther
Which Network(s) would you like to take part in?

Use of technology to help people be more independent or to prevent harm.Involving people with lived experience in strategic decision making in adults social care.
You must tick all boxes to apply to join an IMPACT Network*

I am willing to take part in an IMPACT Network, involving 4 Network meetings between September 2024 and February 2025.I have lived experience of adult social care.I agree to be contacted by email by the co-ordinator, with more details about the Networks and what happens next.I understand that I may withdraw my interest at any time and my contact details will then be removed from our records.
Now SUBMIT the form, by clicking on the green button below.
Contact Amanda McMurray if you have questions about IMPACT Networks or your involvement.

Email: amanda.mcmurray@hscni.net

Thank you.
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APPLY TO JOIN AN IMPACT NETWORK

Have your views heard and work towards change. Apply to join a network by completing the sections below:

Now SUBMIT the form, by clicking on the green button below.