Wessex Making Every Contact Count Train-the-Trainer Programme (MECC) Application Form

Please complete the following information and email a completed form to

Applicants will be notified of the outcome and offered dates via email.

Name…………………………………………..………………………………………………………………………………………..

Organisation…………………………………………………………………………………………………………………………..

Date. …………………………………………..………………………………………………………………………………………..

The following criteria will be used for selection:

·  Relevance to role

·  How Making Every Contact Count training will be rolled out in the organisation

·  Previous experience in delivering training

·  Be confident in group facilitation.

By attending this programme you agree to:

·  Be prepared to complete the Wessex Making Every Contact Count Healthy Conversation Skills Train-the-Trainer training

·  Be committed to maintaining skills through attending additional Continuing Professional Development (CPD) sessions.

·  Be able to deliver Making Every Contact Count training in Wessex for either your own organisation or externally.

Once trained Trainers need to complete and submit Evaluation & Trainer Accreditation Pack paperwork. This allows the School of Public Health to assess Trainers competence. Approved MECC Trainers will then be on a Wessex Register of Trainers. All Organisations and Trainers will agree to the Wessex MECC Trainer Best Practice Agreement to ensure Trainers are fully supported by their employers to become Making Every Contact Count Healthy Conversation Skills Trainers.

For supporting information on the Wessex Making Every Contact Count Train the Trainer programme see the Implementation toolkit. http://www.wessexphnetwork.org.uk/mecc.aspx

Please ensure all responses do not exceed 200 words.

Personal Details (please complete all fields)

First Name and Surname
Your Role
Organisation
Email Address
Phone Numbers (please provide your Office and Mobile phone numbers)
Do you have the full support of your Line Manager to attend this programme?
Yes/No / Line Manager Name:
Line Manager Email:
Line Manager’s statement in support of this application :
By completing this section the Line Manager understands that if successful the applicant will:
·  Be supported to complete the Making Every Contact Count Healthy Conversations Skills Train-the-Trainer training
·  Be supported to deliver Making Every Contact Count Healthy Conversations Skills to others in Wessex
·  Be supported to ensure Making Every Contact Count Train the Trainer skills are maintained by attending additional CPD sessions.
·  Be supported to deliver on the Wessex MECC Best Practice Agreement.
Please outline what experience you have in delivering training to groups
Please tell us how you plan to roll out Making Every Contact Count training within your organisation
Please tell us what your reasons are for applying to become a Making Every Contact Count Trainer
Please tell us how your organisation/employers plan to support you in taking up the role of a Making Every Contact Count Train-the-Trainer?
What makes you a good candidate for a place on this programme?

2

Train-the-Trainer Application Form v4 28.12.16