Application Form

Learning Disability Transforming Care Leadership Development programme

Dates
8 June 2017
13 July 2017
13 September 2017
5 October 2017
9 November 2017
7 December 2017
18 January 2018 / Venue
Apollo Basingstoke
Apollo Basingstoke
Apollo Basingstoke
Apollo Basingstoke
Hampshire Court Hotel, Basingstoke
Hampshire Court Hotel, Basingstoke
Apollo Basingstoke

Please complete the following information and email this form to Closing date for all applications is Friday 14 April 2017. Applicants will be notified of the outcome as soon as possible after that date. Selection will be carried out by programme faculty. Application does not guarantee a place.

The following criteria will be used for selection:

  • Alignment of personal objectives for the programme with theprogramme content
  • Demonstration of commitment to personal leadership development
  • Acceptance of the cancellation policy
  • Support from your employer

If you are offered a place you will be required to undertake the Healthcare Leadership Model (HLM) self-assessment prior to the start of module 1. This is a free-of-charge resource. You will need to download, print and bring your report to module 1.

You will also be invited to a telephone coaching session which will take place before the first event.

Please answer all the questions on this application formon pages 2 to 4 - feel free to expand the form as required to suit your answers.

Personal Details (please complete all fields)

Name (First Name and Surname)
Your Role
Your Employing Organisation
Dietary and access requirements
Email Address
Phone Numbers
(please provide your Office and Mobile phone numbers)
Invoicing address
(for late cancellation or non-attendance)
Do you have the full support of your Line Manager/ Organisational Sponsor to attend this programme?
YES / No / Line Manager/ Organisational Sponsor Name:
Line Manager’s or organisational sponsor’s statement in support of this
application -
Biographical Information
Length of time in your current role:
Using the NHS Healthcare Leadership Model as a framework, outline the leadership responsibilities in your current role()
Outline what (if any) leadership development activities you have under taken in the last 2 years and the outcomes achieved.
The Transforming Care programme is now changing how we deliver and commission services to enable people with learning disabilities and or autism, with behavior that challenges, including a mental health condition, to live in the community closer to home. Outline how you think this leadership programme will develop your ability to ensure people with a learning disability really can live in the community closer to home.
Please describe a piece of work which demonstrates that you can work with others to enable a change, which is more than just a 1:1 interaction related to improving the lives for people with learning disabilities and use this to tell us what you would like to do better next time, hence what behavioral attributes you wish to develop.
What is the one key outcome from your participation in this programme that you believe will enhance your existing leadership and management skill-set?
Why should we offer you a place on this programme?
IMPORTANT
Application Details & Conditions
This programme is funded in partnership with Health Education England Thames Valley and Health Education England Wessex. In order to successfully complete the programme you are expected to attend all 8 days. It is not possible to attend part of the programme, unless you have mitigating circumstances and your request to partially attend has been accepted by TVWLA.
In order to demonstrate best value to patients and taxpayers, we need to ensure maximum attendance on leadership development programmes and events. Failure to attend without a justifiable reason* will result in NHS TVWLA reporting this absence, and related costs, to your HR Director/Accountable Officer. TVWLA operates a membership model so your employing organisation is making a financial contribution to this leadership programme and will expect full attendance by employees who take up places.
*Workload pressure is not considered a justifiable reason
If you secure and confirm a place on this programme and fail to attend any element your employer/ organisation will be charged £2500 for the total cost of your place.
I have read and understand the application conditions
We cannot proceed with your application unless this box is ticked
Please hold the programme dates in your diary.
Thank you for completing this application form, please return to
by 14 April 2017

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