Dates
Day 1:21st Nov 2017
Day 2:22nd Nov 2017
Day 3:6th Dec 2017
Day 4:16th Jan 2018
Day 5:6th Feb 2018 / Venue
Newbury area,
venue TBC
Please complete the following information and email this form to by 25th October 2017. Applications will be reviewed and decisions communicated as soon as soon as possible after this date.
If you are interested in taking part in this programme, but are unsure if it is for you, you can book to attend one of the two half day taster sessions being held in Oxford on the 11th Oct 2017, or Winchester on the 18th Oct 2017 by clicking here.
The following criteria will be used for selection:
The applicant must
  • work in an Equality, Diversity and Inclusion role and/or have a responsibility for Equality, Diversity and Inclusion
  • have a willingness to engage in personal development
  • have a personal commitment to inclusion
  • have an alignment of personal objectives for the programme with the programme content
  • attend all programme dates
  • have approval from their organisation
  • accept the non-attendance/cancellation policy detailed at the end of this application form.
Selection will be carried out by programme faculty. Application does not guarantee a place.
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. If you are successful and accept your place on this programme we will share your email address with other participants on the programme, and with other cohorts of the programme if this is required i.e. to build a network.
Please read booking terms and conditions below
If successful, final joining instructions will be sent 2 weeks prior to the first workshop.

Personal Details (please complete all fields)

Full Name
Role/title
Your employing organisation
Email Address
Phone Numbers (please provide your Office and Mobile phone numbers) / Office:
Mobile:
Do you have any special requirements?
If you require any special requirements, i.e. access, dietary.
Do you have the full support of your Line Manager/ Organisational Sponsor to attend this programme?
Line Manager/OS Name:
Line Manager/OS email address: / YES
NO
Invoicing Address / Details for programme fees
Please see booking conditions below
Line Manager or Organisational Sponsor’s statement in support of this
application :
Biographical Information
Length of time in your current role:
What attracted you to this programme?
Outline your equality, diversity and inclusion responsibilities in your current role:
Outline what (if any) inclusive and/or compassionate leadership development activities you have under taken in the last 2 years and the outcomes achieved:
How do you think this programme will develop your ability to lead on inclusion within your areas of work and if there are any specific areas that you want to focus your learning upon improving or enhancing:
What are your personal objectives in applying for this programme? And how will you and your line manager/organisational sponsor know if you have achieved your objectives? How will your organization benefit from attendance?
What is the one key outcome from your participation in this programme that you believe will enhance your existing approach to leading on inclusion?
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 5 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 will attend ALL 5 sessions
that you will complete and return any evaluation questionnaires required at the end of the programme and also participate in any post-programme follow up, especially to evaluate long term impact.
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 line manager/employer. 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 £800 for the total cost of your place.
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 programme dates in your diary.