Application Form
Care Home Managers’ Leadership Development Programme

Dates
Day 1: Tuesday 19September 2017
Day 2: Tuesday 17 October 2017
Day 3: Tuesday 14 November 2017
Day 4: Tuesday 5 December 2017
Day 5: Tuesday 9 January 2017 / Venue
TBC
TBC
TBC
TBC
TBC

Please complete the following information and email this form to y5pm Wednesday 19th July 2017.

Applications will be reviewed and decisions communicated as soon as soon as possible after this date.

The following criteria will be used for selection:

  • Demonstration of commitment to personal leadership development
  • Acceptance of the cancellation policy
  • Support from your employer

Selection will be carried out by a virtual panel.

Please answer all the questions below - feel free to expand the form, as required, to suit your answers. If successful, final joining instructions will be sent 2 weeks prior to the first workshop.

Personal Details (please complete all fields)

Name
Role/title
Care Home(name of care home, type and size)
Email Address
Phone Numbers (please provide your Office and Mobile phone numbers) / Office:
Mobile:
Do you have any special requirements?
If you have any special requirements please describe here how we may help and we will contact you
Do you have the full support of your employer to attend this programme?
Please note:
  • Employers will need to ensure managers are released to attend the training and ensure appropriate arrangements are made to cover their travel expenses
  • Employers will be expected to support and facilitate the Home Manager to develop and implement the Leadership Project within the Home/Group.
/ Employer’s name:
Biographical Information
Length of time in your current role:
Previous role(s) :
Please outline what (if any) continuing professional development you have under taken in the last 3 years?
Please outline why you think leadership is important to you and your role?
What are your personal objectives in attending this programme? Please give a considered response to this question.
How will you know if you have achieved your objectives?
IMPORTANT
Booking Details & Conditions
This programme is funded by the Thames Valley and Wessex Leadership Academy. In order to successfully complete the programme you are expected to attend all days. It is not possible to attend part of the programme.
If you are accepted on this programme you will need to commit to the following:
that you attend ALL five sessions.
that you will complete the Leadership Project outlined on Day 1.
that you will complete and return any Evaluation questionnaires required at the end of the programme.
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 charging a cancellation fee of £800.
*workload pressure is not considered a justifiable reason.
Your application will be reviewed by programme faculty.
I have read and understand the booking conditions
We cannot proceed with your application unless this box is ticked
Thank you for completing this form, please return to:

Please hold all the programmedates in your diary.