Practise Hope Application Form

Practise Hope Application Form

Supporting primary care practices in helping children and young people around suicide and self harm
Primary Care Practice details
Name of Practice
Practice Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Practice main phone number

Area CodePhone Number
Name and Title of key contact at practice

PrefixFirst NameLast Name
Job title of key contact
Key contact phone number

Area CodePhone Number
Key contact email address
example@example.com
Details about your service
Names of Core Team making the application (e.g. Lead Clinician, Practice Nurse, Practice Manager etc)
Tell us a little about your practice population and characteristics (in brief)?
Tell us a little about your staff team?
Why does your team want to join the Practise Hope programme?
How did you hear about Practise Hope?
Please confirm your practice's agreement with the following:

We are willing to share lessons learned / best practice (as this forms a key part of the initiative).We are willing to provide feedback on the Practice Hope info / process (to help the core project team in planning for potential wider roll out in future).We wish to apply for the £1000 funding attached to this scheme.We commit that we will complete the Practice Hope process.
Thank you for your application - please click on Submit below to complete it.

The Practise Hope core project team will review all applications after the closing date (5th August for Kent and Surrey; 30th August for Brighton & Hove), and will be in touch within a fortnight to confirm next steps.

If you have any queries in the meantime please contact Jody Williams at jody.williams@sussexpartnership.nhs.uk.
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