FORM B: Request for a Windmills Workshop

Please refer to the “How to arrange a Windmills Workshop” for details on how to arrange a Windmills Workshop.

This form should be completed if you would prefer the Deanery to liaise with the group of Windmills Champions and nominate somebody to deliver your Windmills Workshop. Please note that Windmills Champions are more likely to volunteer to deliver your proposed Windmills Workshop if given at least 3 months notice and as many alternative dates as possible.

When the Form is completed, please send it to to liaise with the Windmills Champions.

If you know which Windmills Champions you will ask to deliver your Windmills Workshop, you should complete Form A.

Section 1 Organiser: (Trust or Speciality Details)

Principal Point of Contact (to be filled in by organisation requesting the workshop)

Name: / Job Title: / Organisation:
Address: / Tel. No. (Work):
(Mobile):
Email:
Fax No:


Section 2: Venue

Proposed location of Windmills Workshop:

Section 3: Possible Dates & Times

Please list as many potential dates for your workshop as possible.

1 dd / mm / yyyy / 6 / 11
2 / 7 / 12
3 / 8 / 13
4 / 9 / 14
5 / 10 / 15

Please circle all viable options:

Half day: Yes / No Morning Afternoon

Full day: Yes / No

Section 4: Details of Audience

Target audience: Please indicate the grade and specialty (if appropriate) of the intended audience. Please also indicate if you are prepared to consider applicants from other Trusts / specialties if your workshop is undersubscribed.

Potential Audience: Grade
Potential Audience: Specialty
I am / am not prepared to consider applicants from other trusts / specialties if this workshop is undersubscribed (please delete as necessary)


Section 5: Learning Objectives

Expectations/Objectives from attending. We assume that the workshop will deliver a time for individuals to reflect on their careers and identify career goals. Please indicate below any additional learning objectives you wish to see achieved during your Windmills Workshop.

1.
2.
3.

Section 7

I have read the document “How to arrange a Windmills Workshop” and agree to provide the Windmills Champions with an appropriate venue for the Windmills Workshop

Name:

Date:

Please send this form to to liaise with the Windmills Champions. You will be notified of the Windmills Champions nominated for your Windmills Workshop as soon as possible. You should then liaise with them directly and complete Form A to register your workshop.

Thank you

REQUEST FOR A WINDMILLS WORKSHOP Page 3 of 3