Application Form
EMCC PractitionerProgramme
Coaching Skills
Pre-programme calls:TBC
Workshop 1: 25 & 26th January 2017
Workshop 2: 9 & 10th March 2017
Workshop 3: 26th & 27th April 2017
Workshop 4: 14th 15th June 2017
Coach Integration Day: 15th September 2017
Post programme calls: TBC
Venue: Central London location TBC
NB: Participants must be able to attend and commit to all of the above dates.
Please complete the following information and email this form to:

Closing Date for applications: Friday 18thNovember 2016.
Successful applicants will be notified of the outcome by email on the 12thDecember 2016.
The following criteria will be used for selection:
  • Demonstration of commitment to the development of others
  • Demonstration of how coaching skills will be of individual, team and organisational benefit
  • Current needsof the Coaching service in London
  • Existence of current coaches in the applicant’s organisation.

1. Personal Contact Details
Name:
Preferred Postal address:
Telephone (W)
Telephone (m)
Preferred Email address:

2. Biographical Information

Job title:
Organisation:
Length of time in current role:
Number of people you manage:
Please outline what type of development you have undertaken in the last two years.
What has had the greatest impact on you?

3. Questions

The following questions are intended to elicit an understanding of your experience and your approach to the development of coaching skills. They also provide an opportunity for you to reflect on your own attitude to coaching and its place within your professional role and responsibilities. They are not a test of your coaching skills.
1. What are your personal objectives in applying for this programme?
(200 words)
2. Where does coaching play a part in your existing role as a manager and leader?
(200 words)
3. What qualities or behaviours do you currently have which might help you be an effective coach?
(200 words)
4. How will you utilise your coaching skills following completion of the programme to the benefit of your own organisation and the wider NHS system?
(200 words)

I confirm I am available to attend all of the programme dates and understand that I will need to meet the coaching practice requirements of the programme which are to complete the course to accreditation, join the coaching and mentoring register, committing to coach at least three coachees in 12 months, and attend Continuing Professional Development (CPD) and supervision as required.

Yes / No

Name:

Signature ……………………………………………… Date……………………………………….

Please provide a statement of support from your manager below and recognition that the all programme elements must be completed and committed to in full:

Line Managers Name:Job Title:

Line Managers Email:

Signature ………………………………………………………………………………………… Date………………………………………….

How do you see coaching fitting into this applicant’s existing role, and how will you enable the applicant to have the time to put their skills into practice (which includes making a commitment to undertaking study to accreditation at EMCC Practitioner level, providing coaching for at least three clients per year, and attending appropriate CPD and supervision)?
(50 - 100 words)

Equal opportunities monitoring form

This part of the form will not be part of the selection process and will be collated separately for our monitoring of equality and diversity.

  1. Please tell us your age:
Under 16
16-21
21-29
30-39
40-49
50-59
60-69
70-80
80+
Rather not say
/
  1. Do you consider yourself to have a disability?
No
2b.If yes do you have a:
Physical impairment
Sensory impairment
Learning disability
Mental health condition (long term)
Other health condition (long term)
  1. Ethnicity
Asian or Asian British
Bangladeshi
Indian
Pakistani
Any other Asian background
Black or Black British
African
Caribbean
Any other Black background
Mixed
White and Asian
White and Black African
White and Black Caribbean
Any other mixed background / White
White British
White Irish
Any other White background
Other ethnic group
Chinese
Any other ethnic group
Please state: ______
Rather not say
  1. Gender
Female
Male
Rather not say / 4b.Gender reassignment
Do you now, or have you ever considered yourself to be transgender? (tick if yes)
  1. Religion or beliefs
Atheism
Agnosticism
Buddhism
Christianity
Hinduism
Humanism
Islam / Jainism
Judaism
Sikhism
Any other religion/belief
(please state)______
No religion or belief
Rather not say
  1. Sexual orientation
Bisexual
Gay man
Heterosexual / Lesbian/gay woman
Other
Rather not say
  1. Are you currently providing support to a partner, child, relative, friend or neighbour who could not manage without your help or/and support?
No
  1. Clinical background
Have a clinical background although not currently working in a clinical role
Clinician currently working in a clinical role
No clinical background
Rather not say
  1. Do you require any adjustments to be considered to help you access the programme?
......
NO
  1. Please state here any other specific requirements that we should be aware of:

1