To Be Completed by the Manager Or Chairperson of the Organisation Requesting Cook It

APPLICATION FORM FOR FOOD VALUES

To be completed by the Manager or Chairperson of the organisation requesting Food Values Training for an employee/volunteer.

Name Manager/Chairperson Title of Manager/Chairperson Name of Applicant Name of Organisation Organisation Address Contact Telephone Email Address

When do you plan to deliver Food Values Training?

(If completing form electronically - double click on Yes/No box to mark it as ‘checked’) Yes No Do you support this application? Has your organisation identified funding to deliver Food Values?

Declaration Yes No I have read and understand the Food Values information leaflet I will allow named applicant to attend Food Values training I agree to delivery of 2 food values programmes per year I will ensure facilities & insurance are appropriate I support the member above in the time it will take to prepare and deliver the food values programme I understand a member of the Cook It! team will carry out a visit during programme delivery

Signed: Date:

Please return completed Application Form to The Cook it! Team, First floor – The Spine, Braid Valley Hospital, Cushendall Road, Ballymema, BT43 6HL. Tel: 028 2563 5276 E-mail: [email protected] August 2015