• Current Personal details
  • Employer contact details
  • Support in NI
  • Learning and development activity
  • Learning and development objectives
  • Evaluating the award
  • Complete

Personal details

Please ensure you have read and understood the full terms and conditions on our website before submitting an application.

Please provide details of your professional registration or membership.

Employer contact details

Click here to enter your address manually.

Support in NI

Supporting people affected by motor neurone disease (MND) in Northern Ireland

What percentage of your role is spent working with people affected by MND?
How often do you provide care or support to people affected by MND?
Maximum 400 words.

Learning and development activity

Maximum 400 words.
Do you require financial assistance with travel and/or accommodation?

Learning and development objectives

Maximum 400 words.
Maximum 400 words.

Evaluating the award

Please tick all of the following boxes
Would you like to receive regular updates on the work we are doing and ways in which you can be involved, these could include educational newsletter, or invites to educational or special events?
Communication preferences