Camden Patient & Public Engagement Group (CPPEG)

2018 elections –West Locality Nomination Form

We are delighted that you would like to nominate yourself to join CPPEG. Please read the instructions below before filling out this form.

How to fill out this nomination form

In your personal statement, please explain why you are nominating yourself for CPPEG. Outline clearly the skills and experience which you will bring to the group. What would make you a valuable member of the group? What motivates you? Why should your fellow PPG members vote for you?

Please attach a photograph of yourself. We will share your photograph and personal statement with PPG members. We will not share your email or home address. You must declare any conflicts of interest.

What are the commitments of the CPPEG role?

If elected, you will be expected to:

  • Attend the majority of your General Practice PPG meetings
  • Attend the majority of CPPEG operational meetings (6 operational meetings held during the year)
  • Attend the Camden wide PPG forum meetings (2 forum meetings are held during the year)
  • Work towards sitting on at least one CCG committee OR be prepared to sit on at least one committee
  • Undertake a Disclosure and Barring Service (DBS) check. (A criminal record does not necessarily exclude you from becoming a CPPEG member)
  • Sign an honorary contract for holding a volunteers role at the CCG

Are you eligible?

Please check that you fit our eligibility criteria. You must:

  • Be a member of your General Practice Patient Participation Group (PPG); and
  • Have attended at least one PPG meeting in the past year; or
  • Be part of your practice’s online PPG.

Email your completed form to or call 020 3688 1755. If you have any questions, please don’t hesitate to contact us. The deadline is Friday 2nd March 2018.

Camden Patient & Public Engagement Group (CPPEG)

2018 elections –West Locality Nomination Form

Nomination Form
  1. Full name

  1. Name of your General Practice

  1. Your email address

  1. Your home address

Personal statement: please explain in detail why you would like to be considered for the CPPEG role. Outline how your skills and experience will contribute to the group. Why should people vote for you? (max. 250 words). Please continue overleaf if needed.

Camden Patient & Public Engagement Group (CPPEG)

2018 elections –West Locality Nomination Form

Are you aware of any potential conflicts of interest?
A conflict of interest refers to any role or relationship you have which the public could perceive as influencing or impairing your decision-making in CPPEG.
Some conflicts can be managed, others may exclude you from the role.

Please return your completed form to by Friday 2nd March 2018. Good luck in the election.