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Case study nomination form doctor02

If you would like to nominate yourself, please fill in the form below or alternatively click here to download the form and return by post to:

Loren Grant
Equality, Diversity and Human Rights
NHS North West
3 Piccadilly Place
Manchester M1 3BN

First Name
Surname
Job Title
Job Banding
Employer
Department
Location
Email Address
Daytime Telephone
Mobile
Age
If you would rather not specify your exact age, please select from the following age bandings:
Brief Background e.g. Entry route (e.g. degree or diploma) Brief overview of career to date Any barriers encountered/overcome/not overcome Why you might recommend working in the NHS to others with a similar background to you
Department Manager
Your organisation’s communications/press office contact (if known)
Please tick this box if you would also like to feature as a case study for videos we are developing for the project