Connecting for Life South Tipperary Implementation Steering Group - Nomination Form July 2022

Connecting for Life South Tipperary Implementation Steering Group seek one PPN represent

Connecting for Life (CFL) implementation steering group - South Tipperary is the Action Plan to Prevent Suicide seek one PPN representative for their board.

This plan is based on Connecting for Life, Ireland’s National Strategy to Reduce Suicide. CFL South Tipperary was developed in response to a comprehensive community consultation in South Tipperary where members of the public, families, communities and a wide range of organisations were given the opportunity to decide what needed to happen in South Tipperary in relation to suicide prevention.

There are 52 local actions under 7 strategic goals that address all elements of mental health promotion and suicide prevention, intervention and postvention. The implementation steering group (ISG) is made up of a number of representatives and stakeholders who either work in the area, are representing communities, have personal experience or have lead responsibility for the implementation of actions in the plan.

The representative should have good communication skills so that (s)he can bring the PPN member groups’ views to the table and bring information back to PPN groups

Connecting for Life South Tipperary Implementation Steering Group meet 4 times a year.

Please note: This could be a difficult role for someone who has been bereaved through suicide or experiencing their own difficulties but this does not prevent anyone from becoming a PPN rep.

The form will then close and no other organisations will be able to nominate a representative after that date/ time. The nomination results will then be released and an election will take place if there is more than one nominee.

**Please read the PPN Roles and Responsibilities and Tipperary PPN Nomination Guidelines carefully to ensure your candidate is eligible

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* 1. Is your organisation/ community group a member of Tipperary PPN ?
(Please note: A nominating organisation must be a member of Tipperary PPN to be eligible for this seat.)

Yes

Other (please specify)

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* 2. Does your organisation/ group operate in South Tipperary?
(Please note: A nominating organisation must operate within South Tipperary to be eligible for this seat. If you do not operate within South Tipperary please explain your interest in the Steering Group)

Yes

Other (please specify)

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* 3. Name of your organisation/group?

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* 4. Proposing Organisation details

Name

Address

Telephone No.

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* 5. Selected Nominee Details

Name

Address

Telephone No.

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* 6. Nominee's interest/ expertise which will aid the Connecting for Life South Tipperary Implementation Steering Group
(Note: This script will be used as a short bio in the case of an election)

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* 7. Please list any previous community representation on boards/ committees
(Note: This script may be used as a short bio tin the case of an election)

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* 8. Other relevant experience
(Note: This script may be used as a short bio tin the case of an election)

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* 9. By ticking the boxes below you are agreeing to the following statements:

Our organisation are active members of Tipperary Public Participation Network (PPN)

The proposed nominee has the support of the organisation

The nominee agrees to work with the PPN, Secretariat and any other PPN Linkage Groups

The nominee will represent the views of the wider linkage group and geographical area not just their own views

We have read the nomination guidelines for the PPN and understand our candidate to be eligible (see above)

You have the permission of the nominee to share their details with the PPN

Name of proposing contact in organisation and name of nominee who have agreed to these statements (must not be the same person)

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* 10. Do you agree to share your contact details with PPN members? Please tick all that apply
(If completing application on behalf of nominee please only supply details if you have permission to do so)

Phone

Question Title

* 1. Is your organisation/ community group a member of Tipperary PPN ? (Please note: A nominating organisation must be a member of Tipperary PPN to be eligible for this seat.)

Question Title

* 2. Does your organisation/ group operate in South Tipperary?(Please note: A nominating organisation must operate within South Tipperary to be eligible for this seat. If you do not operate within South Tipperary please explain your interest in the Steering Group)

Question Title

* 3. Name of your organisation/group?

Question Title

* 4. Proposing Organisation details

Question Title

* 5. Selected Nominee Details

Question Title

* 6. Nominee's interest/ expertise which will aid the Connecting for Life South Tipperary Implementation Steering Group(Note: This script will be used as a short bio in the case of an election)

Question Title

* 7. Please list any previous community representation on boards/ committees(Note: This script may be used as a short bio tin the case of an election)

Question Title

* 8. Other relevant experience(Note: This script may be used as a short bio tin the case of an election)

Question Title

* 9. By ticking the boxes below you are agreeing to the following statements:

Question Title

* 10. Do you agree to share your contact details with PPN members? Please tick all that apply (If completing application on behalf of nominee please only supply details if you have permission to do so)

* 1. Is your organisation/ community group a member of Tipperary PPN ?
(Please note: A nominating organisation must be a member of Tipperary PPN to be eligible for this seat.)

* 2. Does your organisation/ group operate in South Tipperary?
(Please note: A nominating organisation must operate within South Tipperary to be eligible for this seat. If you do not operate within South Tipperary please explain your interest in the Steering Group)

* 6. Nominee's interest/ expertise which will aid the Connecting for Life South Tipperary Implementation Steering Group
(Note: This script will be used as a short bio in the case of an election)

* 7. Please list any previous community representation on boards/ committees
(Note: This script may be used as a short bio tin the case of an election)

* 8. Other relevant experience
(Note: This script may be used as a short bio tin the case of an election)

* 10. Do you agree to share your contact details with PPN members? Please tick all that apply
(If completing application on behalf of nominee please only supply details if you have permission to do so)