<p>Wheelchair Skills Trainer Application Form</p><p>Back Up Wheelchair Skills Training delivers structured peer-led training in spinal centres and on residential courses throughout the UK. If you are interested in becoming a wheelchair skills trainer please fill in the form and return it to Back Up. </p><p>Personal Details</p><p>Name D.O.B. Injury Level Complete Incomplete Can walk Date of Injury* Mobile number *we would normally expect trainers to be a minimum of 2 years post injury though this is not always essential</p><p>Please check as appropriate</p><p>I am prepared to attend a Wheelchair Skills Train the Trainer Course 6th – 9th April 2018 (4 days)</p><p>I am happy to complete a DBS check</p><p>I can commit to volunteering approx days per year</p><p>I have access to a car or can travel by public transport to spinal centres/courses to deliver training for Back Up</p><p>Wheelchair Skills</p><p>In order to work most effectively with a broad range of people, we are keen to recruit both male and female trainers, paras and tetras (including powerchair users) and a range of ages. You will not be required to perform all skills and your potential as a role model and your ability to teach is more important than your ability to do all wheelchair skills. However, it is helpful to have an idea of your skill level, so please tick the boxes below and give any further details if necessary.</p><p>Details (if necessary) Hold a back wheel balance Go up and down a curb Go over a threshold Transfer from floor to chair Go down stairs with a handrail Set-up a wheelchair Powerchair user </p><p>The Back-Up Trust, Jessica House, 191 Wandsworth High Street, London, SW18 4LS Registered Charity Number 1072216 Further details</p><p>1. What have you been up to since your injury? (eg education, work, leisure, travel) </p><p>2. What experience do you have that would help in your role as a trainer?  </p><p>3. Please give details of anything else to support your application? </p><p>4. Please use the space below for any other comments you may have. </p><p>Please return this form by post or by email – [email protected] </p><p>THANK YOU!</p><p>The Back-Up Trust, Jessica House, 191 Wandsworth High Street, London, SW18 4LS Registered Charity Number 1072216</p>