1.Name of person completing this form

2.Email Address

3.What HSCP can attend this event?

Physiotherapist only

Interdisciplinary

4.Other professions that can attend this training?

5.Description of the proposed CPD event/training: title, presenter information

6.Details on previously held similar event/training and its impact, if applicable:

7.Are you aware of a potential HSE venue for the delivery of the activity?

8.What is the approximate cost to run this event/training?

9.Rationale for the proposed CPD event/training: Example, assessment of learning needs, evidence based practice, existing service needs, training required to implement new models of care and care pathways, spreading innovation, etc.

10.Alignment of proposed CPD event/training to CPD recommendations of the National HSCP Office (HSCP Deliver, HSE priorities, Supporting new posts, Scheduled care specialties)

11.Benefits of providing this CPD event/training to service user

12.Benefits of providing this CPD event/training to service

13.Benefits of providing this CPD event/training to the individual HSCP

14.Please be aware that completing this form does not guarantee a place on the course

Yes

15.I understand that if my proposal is selected the ISCP will apply to the National HSCP Office on behalf of the profession for funding for the activity. If funding is awarded the ISCP will deliver the activity in line with the terms of its agreement with the National HSCP Office

Yes

16.By submitting this application you agree to your data being processed in accordance with the ISCP Privacy policy. You also agree to being contacted in relation to this application should further information be required

Yes