Rosalind Franklin Application Form – Application form for the NHS Leadership Academy's Rosalind Franklin programme

Application-ID
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Submission Date
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Privacy Agreement

Any information you provide in completing this application will be stored and processed in accordance with our Data Privacy Policy which you are required to read and accept before completing your application.

By proceeding with this application, you agree that The Leadership Academy may contact you if you have partially completed your application to offer guidance and support with finishing your application.
This is a separate agreement to the marketing preferences selected further in this application.
Please check the box below to accept the above agreement and our Data Privacy Policy*
I confirm I have read and accept the Academy’s Data Privacy Policy and above agreement

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About you
This form is inactive, please do not continue with your application as your application will not be counted.
Name*
First Last
Preferred Name
Preferred Email*

Your primary email address
Preferred contact number*

Your main contact number with international dialling code and extension if necessary
Date of Birth
DD dash MM dash YYYY
Please enter your 10-digit Academy ID*

If you already have an Academy ID, please log on to our new Academy Profile system using your existing log in details to ensure your account is transferred to our new system.

If you need help remembering your existing Academy ID, please use the Reset password feature on the Profile system.

If you do not have an Academy ID, please register on our Academy Profile system to create one.
Home address*
Street Address Address Line 2 City ZIP / Postal Code Country
Region*
I confirm that:*
I am employed by the NHS and work in Occupational Health and Wellbeing services at least 0.4 WTE (i.e. 2 days per week)
My manager/organisation supports my application
I acknowledge this is a fully funded programme subsidised by NHS England and Improvement, and I will give back by:

-- Completing the programme and all learning activities

-- Using the learning to make a positive difference to my workplace, Occupational Health services, and the wellbeing of healthcare employees

-- Participate in the robust evaluation activity during and at the end of the programme to share my experience, demonstrate the impact of the programme, and help NHS England and Improvement make the case for further investment to support future cohorts or Occupational Health leader development.

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Cohort
Participants on this programme are divided into cohorts. Each cohort has a number of events which you must be able to attend.

You can see details of available cohorts on this web page.
Attendance at all cohort events is mandatory. Please check the dates and locations of workshops and other events on the web page link above and then select your preferred cohort below:
For the full list of cohort dates, please refer to the Growing OH prospectus.

Preferred Cohort*

Cohort 38 – North East and Yorkshire

Cohort 39 – Midlands

Cohort 40 – North West

Cohort 41 - London

Cohort 42 – East of England

Cohort 43 – South West

Cohort 44 – South East

OH Preferred Cohort*

Cohort 2
Start date 16 May 2022

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Employment Information
Please enter the details of your current main job role.
Organisation*
Country*
Please select your country
Organisation Type*

Please enter the type of organisation
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New Organisation
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Organisation Name*

Please enter the name of the organisation
Organisation Post Code*

Please enter the post code of the organisation
Is this an NHS organisation?*

Yes

No
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Does this organisation provide any NHS-funded care?

Yes

No

Don't know
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Organisation Region*
Role*
Area of work*
Job Title*

Please enter your job title
Salary/Band*
Current?*

Yes

No
Are you currently active in this role? Please note: we only require past roles if you are unemployed.
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Admin Note: Line Manager
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Line Manager Name
First Last
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Line Manager Job title
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Line Manager Email
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Line Manager Phone

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Funding

NHS England and Improvement is fully subsidising the cost of this programme
Funding
Your place is being fully funded by Surrey Heartlands ICS.

Please click next to continue your application.
Funding
The Rosalind Franklin programme costs £1,200 per person. The cost is fully inclusive of the three face-to-face or virtual workshops.

If you intend for your organisation to fund your place on this programme, please do not continue with this application unless funding has been secured in agreement with your line manager.
How will your place on the programme be funded?*Please indicate the method you will use to fund your place on the programme. If you are sharing the cost with your organisation then choose the second option as you will be responsible for obtaining the funds from your organisation. Please check with your line manager or finance team if you are unsure how your place will be funded.

An organisation will be funding my place

I will be funding my place
Does this organisation provide NHS funded care?*

Yes

No
Internal Transfer?
Yes
Check this box if your organisation is eligible to pay by direct internal cost-centre transfer rather than invoice. If in doubt, leave this box unchecked and we will invoice you.
Budget holder email address*

If you are being funded by your organisation please note the email address of your budget holder (or other authorised person) above. If you are self-funding please note your main email address used in the 'about you' section.

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Equality & Diversity
We hold the principles of equality and inclusion at the heart of everything we do and all that we stand for. Each programme is held to account for its inclusion practice through a review of anonymised statistics based on this data. Your equality and diversity data is not used to determine the success of your application. This data is stored securely in compliance with the General Data Protection Regulation (GDPR) 2016.
Which of the following best describes your gender?*
Are you now or have you ever defined yourself as Trans?*
Which of the following best describes your sexual orientation?*
Which of the following best describes your ethnic background?*
Which of the following best describes your religion or belief system?*
Which of the following best describes your nationality?*
Do you consider yourself to have a disability?*
Many people do not consider themselves to be disabled. However under the Disability Discrimination Act 1995 and the Equality Act 2010, you are protected from discrimination if you have a physical or mental impairment or long term health condition, the effects are expected to last – or have lasted – for a year or longer and have a substantial impact on your ability to carry out day to day activities; or your day to day activities would be limited without medication, treatment or adjustments (for example the use of inhalers, physiotherapy, a hearing or visual aid or insulin). Taking this into account, do you consider yourself to have a disability?
About your disability

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Personal Statement
Personal Statement

NHS England and Improvement is subsidising the usual fee of £1,200 to attend this well-established NHS Leadership Academy development programme as a bespoke cohort for the Occupational Health Community. This is part of our commitment as part of the national Growing OH programme, to grow and develop our Occupational Health and Wellbeing leaders and our OH services to help improve the wellbeing of all our NHS people. With this in mind we would like to know more about you, what you hope to gain, and how you will use the learning from the programme to ‘give back’ to improving Occupational Health and Wellbeing services in your leadership role. We will use this to assess your readiness and suitability to take part in the programme.
Tell us about your current role and the people/projects/kind of work you lead, demonstrating the complexities and challenges. (250 words)*
(250 words)
Tell us what you hope to be able to bring to the programme and how you'll use your learning to help make a positive impact for both staff and patients/service users. (200 words)*
(200 words)
Why have you chosen this programme, why now, and what do you hope to achieve?*
(200 words)
What are you passionate about, and hoping this programme will help you address, in your work place?*
(250 words)
What arrangements will you make to create time to study for at least 15-20 hours a month?*
(100 words)
About you and your role: Tell us about your current role in Occupational Health and Wellbeing and the people/projects/kind of work you lead, demonstrating the complexities and challenges?*
(250 words)
Personal development hopes: Why have you chosen this programme, why now, what do you hope to bring to the programme, and what do you personally want to achieve on your own leadership development journey?*
(200 words)
Leading Occupational Health: How will you use the learning from the programme to ‘give back’ to growing Occupational Health and Wellbeing services as a leader?*
(200 words)
Improving Occupational Health: What changes and improvements are you hoping to make in Occupational Health and Wellbeing, how do you hope to use learning from this programme to enable you to achieve this, and how will you know you’ve been successful?*
(200 words)
Commitment to programme: What arrangements will you make to create time to study for at least 15-20 hours a month?*
(100 words)

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Keeping in touch

We'd like to keep in touch with you on updates about our products, services, promotions, news and events. Please select your preferences to help us keep you up-to-date
Where did you hear about the programme?
Would you like to receive updates from the Leadership Academy about other programmes on offer?
Would you like to receive updates from the Leadership Academy about other learning opportunities such as bite size learning, mentoring, news and events?
Would you be happy to be contacted by the Academy for research purposes?
(Your views are important to us and help us grow).
At the moment updates are delivered via email but we are exploring options to communicate via mobile, would you be happy to receive notifications from us via mobile in the future?

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Terms and Conditions
1. I confirm that all the information provided in the application form is up to date and accurate.

2. If I am from outside the EU and working in England with a visa; I confirm my UK visa and immigration clearance covers study as well as work.

3. I have the full support of my line manager to take part in the programme and they have agreed, on behalf of my organisation, to make the necessary work place arrangements and allow me time away from work in order for me to attend all of the face to face elements.

4. I will attend and partake in all the face-to-face / virtual workshops and all the learning activity associated with the programme, including all the assignments regardless of the amount of study leave I am granted. Not attending the programme without agreeing extenuating circumstances with the NHS Leadership Academy could mean that I may lose my place on the programme.

5. I understand that all the elements of the programme are compulsory and attendance is part of the assessment, pass mark, and NHS Leadership Academy accreditation. I understand that the assessment criteria are as follows:

a) Completion of all online work through the Virtual Campus

b) Mandatory attendance at all three workshops and all five impact groups

c) Contributions to online discussions

d) Submission of a 5,000 word impact written assignment.

6. I understand that the programme is designed around practical learning in the workplace – the most important environment for me to learn and develop as a leader – and that I will not be able to complete the programme without application in my workplace. I understand there is an extenuating circumstances policy in place if I struggle to apply the learning in the workplace, which is provided once the programme commences.

7. I acknowledge that I cannot defer on this programme.

8. The amount of paid or unpaid study leave I receive (in addition to the time away from work for the face to face elements of the programme) will be determined by the relevant policy of or by the management of my employing organisation.

9. I understand that my travel costs and subsistence (other than lunches during the face to face days) are not covered by the fees for the programme and my employing organisation’s expenses policy will apply.

10. I understand that if I move jobs during the programme:

a) This does not automatically constitute extenuating circumstances for withdrawal from the programme; and

b) I will make my new employer and line manager aware before I accept the job offer that I am committed to complete the programme and will require their support to do so.

11. If I am self-funding, if, having accepted a place, I either fail to start or fail to complete the programme for any reason whatsoever (other than for a reason that the NHS Leadership Academy in its absolute discretion determines is an extenuating circumstance), I will remain liable to still pay the programme fee and the fee will not be refunded.
Please check the box below to accept our Terms and Conditions*
I agree to the Terms and Conditions

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Summary
Please check your details and, if correct, submit this form.
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Application Form - 2022

Privacy Agreement

About you

This form is inactive, please do not continue with your application as your application will not be counted.

Cohort

For the full list of cohort dates, please refer to the Growing OH prospectus.

Employment Information

New Organisation

Admin Note: Line Manager

Line Manager Details

Funding

Funding

Funding

Equality & Diversity

Personal Statement

Personal Statement

Keeping in touch

Terms and Conditions

Summary