IS4L 2018/19 Cohort
Application Form
IS4L brings a team of 5 people together from your organisation to focus on a specific improvement challenge. They will attend three 3-day workshops in Manchester over the course of a year. The three months between each workshop are action periods, where the team will work together on their project. In this time, the team will report on progress and join monthly WebEx coaching calls.
Contact details of lead applicant for the team
Name (and title)Profession
Job title
Organisation
Telephone
Name and contact details of organisational sponsor (for example: chief executive, medical or nurse director)
Name (and title)Profession
Job title
Organisation
Telephone
- Your project: Please provide a brief statement explaining what your project will focus on. Please include why this is important to you, to patients and to your organisation’s objectives
Your project
- Your role: Please provide a brief statement outlining your current role and how this will link with the project
Your role
- Your team: The IS4 programme is for teams to develop and apply the learning together. Who would be a part of this team and why?
Your team
- Working together: Your improvement team will need leadership. What is your experience in leading teams?
Working together
- Your team’s skills: The IS4 programme will develop you and your team’s ability to deliver improvement. What experience or qualifications do you already have in this field?
Skills
- Your time: Attending the programme and working on your project can take up to a day a month on average. How will you be supported to do this?
Your time
Data Protection Statement
In compliance with the 1998 Data Protection Act, we (Haelo) require your consent to use personal data supplied in the processing and review of this application. Haelo requires your further assurance that personal data about any other individual is supplied to Haelo with his/her consent.
Signed:
Name:Name
Date:Date
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