Leading Integrated Teams

Application Form

Course Start Date: 10th October 2018

Application Deadline: 5pm, 31st July 2018

Team Leader/Co-ordinator Contact Details

First Name:
Last Name:
Organisation:
Job title:
Locality:
Number of staff in the team:
Email address:
Phone:
Line Manager name and email address:

Please provide details of any leadership development you have received in the last 5 years

Course /award title / Date

Please use the following pages to describe why you are applying for this support programme.

Application Questions

You should be able to demonstrate:
That you lead an integrated health and care team or a number of teams and that either:
  • your integrated team is newly-formed or you are new to team leadership or that
  • your integrated team has undergone change, needs to develop new ways of working or needs to innovate or;
  • your integrated team is working well but you want to increase effectiveness even further
Describe your team:
Describe the difference being part of this programme will make to your local system?
(300 word maximum) Describe how you think that you will be able to contribute personally and support the ambitions of your local system.
What do you understand about your learning preferences and style, and in what ways have you incorporated this into your continuing development? (300 word maximum)
In what ways would you manage the demands of participating in the programme against your work and personal commitments?
You will be required to attend all of the programme workshops, complete a pre & post-programme baseline assessment, submit a case study and utilise the Affina Team Journey as a minimum requirement.
(300 word maximum)
Confirmation of Commitment
Please can confirm that you can attend all eightworkshop dates:
  • Wednesday, 10 October 2018
  • Tuesday, 13 November 2018
  • Wednesday, 14 November 2018
  • Wednesday, 12 December 2018
  • Wednesday, 23 January 2019
  • Wednesday, 20 February 2019
  • Thursday, 21 March 2019
  • Tuesday, 30 April 2019

Senior Leader Statement of Support

Name:
Telephone:
Email address:
Job title:
Organisation:
Why this person?
Please tell us why you are supporting this applicant. Please describe how they will be supported by the organisation to undertake the programme (50 words minimum)

Forms should be returned to by

5pm, 31st July 2017