Lady Estelle Wolfson Fellowships for Emerging Leaders 2017

Application pack

Application Form

LADY ESTELLE WOLFSON EMERGING LEADERS FELLOWSHIP PROGRAMME

APPLICATION FORM

The Lady Estelle Wolfson Fellowships for Emerging Leaders are open to female Consultants and SAS grades with at least 5-10 years’ experience since appointment. This includes those who have worked less than full time. There will also be one place offered to an exceptional senior trainee.

Please note:

  • Completion of the fellowship programme will require a time commitment of a minimum of four days spread over the course of a year.
  • It is important to complete all sections of this form
  • Applicants must be a Member or Fellow of a surgical royal college.
  • Those who may have never taken on additional activities and now have more time to give to their careers are encouraged to apply.

Consideration will be given to achieving a spread of appointments with respect to specialty and geographical region.

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Lady Estelle Wolfson Fellowships for Emerging Leaders 2017

Application pack

Application Form

Section One: Contact Details

Name:
Title:
Email(s):
Phone:
Home Address:
Work Address:

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Lady Estelle Wolfson Fellowships for Emerging Leaders 2017

Application pack

Application Form

Section Two: Professional Details

Grade:
Years since appointment:
College Membership (England, Edinburgh, Glasgow, Ireland):
College membership number:
GMC number:
Specialty (select one): / General / Plastic
Vascular / OMFS
Cardiothoracic / Neurosurgery
Urology / ENT
Paediatrics / Dental
Trauma & Orthopaedics
Region (select one): / London (NW) / East Mids
London (South) / West Mids
London (NE) / South Central
North East / SE Coast
North West / South West
Mersey / Wales
Yorkshire & Humber / N. Ireland
East of England / Rep. Ireland

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Lady Estelle Wolfson Fellowships for Emerging Leaders 2017

Application pack

Application Form

Section Three: Professional Activity

Please ensure you complete every part of this section. This information will be used to shortlist applicants.

Maximum 500 words per activity (c.3000 characters. This form will prevent you from entering in excess of 3500 characters).

  • Trust committees / activity
  • Educational roles
  • Academic or research activity
  • Participation in professional society activity
  • Other Leadership activity

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Lady Estelle Wolfson Fellowships for Emerging Leaders 2017

Application pack

Application Form

  • Any additional comments in support of application
  • Statement of suitability (max 200 words, 1700 characters)
    Please explain why you think you would be suitable for the Emerging Leaders Programme.
  • Confirmation of Trust support to participate in this activity if selected

YES

NO

Name
Signature
Date

Please submit your application form to:

or by post to:

  • Membership Engagement, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE

no later than 12 May 2017.

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