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* 1. Contact information

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* 2. Please tell us briefly about your experience of providing end-of-life care for a family member, partner, friend or neighbour (whom have you been supporting/ caring for, when and for how long?)

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* 3. Please tell us a bit about why you would like to be a Carer member on our Review Advisory Panel:

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* 4. Would you be able to contribute to meetings at the University of Manchester about every 3 months for a period of 18 months? (please tick)

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* 5. Would you be comfortable reflecting on your personal experiences and knowledge of caregiving within a group of people?

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* 6. Would you feel able to read documents in English and comment on them?

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* 7. Please let us know if you have any access requirements to enable you to contribute to meetings: 

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* 8. Thank you for your application.

We may not be able to offer all applicants a place on the Carer Advisory Panel but we will respond to everyone.  Please select how you would prefer to be contacted by a member of our team:

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* 9. If we are unable to offer you place on the Review Advisory Panel, may we keep your details for the sole purpose of asking if you may want to participate in future analysis or stakeholder groups for this project?

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