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HII Application Form

HII Application Form
Name
Name
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Last
0 of 100 max words
0 of 100 max words

Social Movement Ignition Group – Leading in your System

You need to select up to 5 nominees from your organisations in your local system, who all have a role in Health Inequalities & Improvement. This could be people from your own organisation or other organisations such as NHS Trust, PCN, NHS Mental Health Trust, Community Trust or even Providers involved in the wider determinants of health. By selecting this box and completing the contact details you agree that you have received written approval from your 5 nominees
Nominee 1 Name
Nominee 1 Name
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Last
Nominee 2 Name
Nominee 2 Name
First
Last
Nominee 3 Name
Nominee 3 Name
First
Last
Nominee 4 Name
Nominee 4 Name
First
Last
Nominee 5 Name
Nominee 5 Name
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Last

Agreements and Approval

By selecting this box and completing the contact details you agree that you have received written approval from your line manager
Line Manager Name
Line Manager Name
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Last