<p> APPLICATION FORM FOR FOOD VALUES </p><p>To be completed by the Manager or Chairperson of the organisation requesting Food Values Training for an employee/volunteer.</p><p>Name Manager/Chairperson Title of Manager/Chairperson Name of Applicant Name of Organisation Organisation Address Contact Telephone Email Address</p><p>When do you plan to deliver Food Values Training?</p><p>(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?</p><p>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 </p><p>Signed: Date:</p><p>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: cookit@northerntrust.hscni.net August 2015</p>