Application Form

TVWLA Health Coaching: Train-the-Trainer

Dates:
23 February 2016
23 March 2016 / Activity
Day 1
Day 2 / Venue
Hawkwell House Hotel, Oxford

Please complete the following information and email this form to

The closing date for submission of application forms is24 December 2015. Applicants will be notified of the outcome as soon as possible after that date.

The following criteria will be used for selection:

  • Commitment to completing all aspects of the training
  • Demonstration of commitment to support the future development of health coaching within your organisation
  • Demonstration of the understanding of the role and impact of health coaching within your organisation
  • Demonstration of a commitment to regularly undertake the role of a health coach and to maintain skills and knowledge through on-going CPD and regular coaching supervision
  • Alignment to the delegate profile
  • Acceptance of the cancellation policy

Please answer all the questions below – feel free to expand the form as required to suit your answers. Please note that we will share application forms, in line with information governance guidelines, with the programme provider to allow them to understand participant thinking and adapt the programme accordingly if required.

Personal Details (please complete all fields)

Name
Role/title
Band/Grade
Email Address work
Email Address personal
Phone numbers (please provide your Office and Mobile phone numbers)
Organisation/ Employer
Invoice address details (in case of cancellation)
PA/Administration Contact details:
/ Email:
Phone number:
Please indicate how many hours you can commit to health coaching a month
Do you have access or special dietary requirements?
Endorsement from your line manager or LDL/HRD endorsement / Name:
Signature:
Title
Length of time in your current role:
Previous role(s) if relevant :
Are you a qualified coach?
If yes please give details of qualification obtained, awarding body and date
Do you have experience of health coaching?
if yes please give details
Please outline what (if any) types or similar development you have under taken in the last 5 years?
What would you most like to get out of your participation in this programme from both a personal and professional perspective?
What can you bring to the table during this 2-day programme and subsequently in your practice, in terms of experience, passion, motivation and understanding?
Have you ever received any coaching?
What plans do you have to develop health coaching in your practice / organisation?
Please indicate below the target group you intend to work with and your success factors/ measures?
In what way will implementing health coaching support the local and national policies/ initiativesin your organisation and system?
Will you be undertaking any other educational programmes during this programme? If so please provide details.
Is there anything else you would like us to know that is important to you?
IMPORTANT
Booking Details & Conditions
This programme is funded by the Thames Valley and Wessex Leadership Academy, excluding backfill, accommodation and expenses (i.e. travel).
In order to successfully complete the programme you are expected to attend and complete the programme in full.
In attending this programme you are expected to become an active Health Coach within the Thames Valley and Wessex geography and also participate in ongoing CPD.
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 or cancel with less than 4 weeks’ notice you/ your employer/ organisation will be charged £1000 for the total cost of your place.
I have read and understand the booking conditions
We cannot proceed with your application unless this box is ticked
Please return completed forms to:
Closing date is 24 December 2015.
Please hold dates in your diaries when submitting your application.