Application form

Our expectation is that you will complete the application as a group/team rather than one person applying on behalf of your Place

Please print clearly in black ink or type

Name of applicant:
Organisation:
Your role in the organisation:
Contact address:
Post code
Tel:
E-mail:

Our expectation is that you will complete the application as a group/team rather than one person applying on behalf of your Place

Please print clearly in black ink or type

Name of applicant:
Organisation:
Your role in the organisation:
Contact address:
Post code
Tel:
E-mail:

Our expectation is that you will complete the application as a group/team rather than one person applying on behalf of your Place

Please print clearly in black ink or type

Name of applicant:
Organisation:
Your role in the organisation:
Contact address:
Post code
Tel:
E-mail:

Our expectation is that you will complete the application as a group/team rather than one person applying on behalf of your Place

Please print clearly in black ink or type

Name of applicant:
Organisation:
Your role in the organisation:
Contact address:
Post code
Tel:
E-mail:

This application is confidential to the programme director and support team. Please use this application only and do not send any additional material.

Return to:Tracy Nottage

Programme Co-ordinator

E:

T: 020 7307 2593

1.Please describe why you are applying to join the learning network.
2.As a team, how have you worked together before?
How do you hope your relationship will develop through participating in the programme and what do you want to learn about?
If you haven’t worked together so far please describe how you hope your relationship will develop through participating in the programme and what you might learn more about.
3.If you are successful in participating in this programme, what do you hope will be different for:
•You personally
•Your organisation
•For your community or system?
4.What are the issues and questions that need to be addressed to ensure that the needs of care home residents are met in an integrated way?
5.This programme will rely on participants’experience as a key resource for the whole groups’learning. As such we ask that you commit to attending all the module dates. Are you able to commit to this?
6.Is there anything you would like to add in support of your application?

This application is confidential to the programme director and support team. Please use this application only and do not send any additional material.

Return to:Tracy Nottage

Programme Co-ordinator

E:

T: 020 7307 2593

The King’s Fund is an advocate of equal opportunities, diversity and inclusion. We would be grateful ifyou could also take a few seconds to fill in our diversity monitoring questionnaire.

Any information provided is anonymised, entirely confidential and will not inform the selection process.This questionnaire is not obligatory but by completing it you will help us monitor the effectiveness of our approach to this issue.The request for this information and the uses to which it will be put are within the scope of the Data Protection Act 1998, which allows for the collation and reporting of sensitive data for monitoring purposes. We are collecting this information in order to establish a better understanding of participants on our programmes.

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