<p> Cwm Taf Together for Mental Health Partnership Board</p><p>Application form for the Role of Service User/Carer Board Member</p><p>If you require help completing this form, please contact Rachel Wyatt on 01443 846200 or email [email protected].</p><p>Name:</p><p>Address:</p><p>Contact Number: Email address:</p><p>For each question, please provide a specific example (s) if you are able to, to demonstrate your values, skills or abilities. Please continue on a separate page if necessary.</p><p>1. Please describe your experience of local mental health services and/or understanding of mental health services in RCT or Merthyr Tydfil.</p><p>1 2. Please describe to what extent you feel Service User /Carer involvement is important in improving mental health services.</p><p>3. Please describe your current links or involvement with Service Users/Carers and/or Service User/Carer groups.</p><p>4. Please describe any experience you have of promoting the perspectives of Service Users / Carers and reflecting their views.</p><p>2 5. Please describe using examples your ability to communicate effectively with a wide range of people both verbally and in writing.</p><p>6. Please describe through example(s) any other experience from paid or unpaid work, hobbies, home life, education or training that would be relevant to this position.</p><p>7. What support do you think you will need to do this role effectively? Please tick as appropriate:</p><p>IT training 1 to 1 peer support Report writing training Administrative support Other training – please state Any other support please state</p><p>8. Do you speak Welsh? Yes No 3 9. If you are able to, please provide at least one character reference:</p><p>Name: Name:</p><p>Address: Address:</p><p>Phone Number: Phone Number:</p><p>Email: Email:</p><p>10.Please indicate below if you need any reasonable adjustments in relation to disability to support your work in this role.</p><p>11.I confirm that I am able to travel to attend the quarterly Cwm Taf Partnership Board and the quarterly National Service User and Carer forum (which takes place in venues across Wales). (Expenses will be reimbursed).</p><p>I understand that this role is subject to an enhanced CRB check.</p><p>SIGNATURE</p><p>I declare that the information provided in this application form is correct. </p><p>SIGNATURE DATE </p><p>Please return to this form to: The Involve 2 Evolve Project, Interlink, 6 Melin Corrwg, Cardiff Road, Upper Boat, PONTYPRIDD, CF37 5BE by Friday 4 th March 2016 or email [email protected]</p><p>This form should be completed in full. C.V.’s will be disregarded. </p><p>4</p>