Application Form
Practice Managers Leadership Programme

Dates / Venue
8th March 2016
19th April 2016
11th May 2016
9thJune 2016
30th June 2016 / Oxford Science Park
Oxford Science Park
Oxford Science Park
Oxford Science Park Oxford Science Park

Please complete the following information and email this form to:

The following criteria will be used for selection:

  • alignment of personal objectives for the workshop with the workshop topics
  • demonstration of commitment to personal leadership development
  • acceptance of the cancellation policy
  • Support from your employer

Please note only applications fromPractice staff in Oxfordshire will be considered. This programme is fully funded by Thames Valley and Wessex Leadership Academy and Oxfordshire Clinical Commissioning Group as part of support received from the Prime Ministers Challenge Fund.

Please answer all the questions below - feel free to expand the form as required to suit your answers. If your place is confirmed, final joining instructions will be sent 2 weeks prior to the first workshop.

Please hold the dates in your diary until you have received confirmation of the outcome of your application.

The closing date for submission of application forms is22 February 2016.

Successful applicants will be notified of outcome as soon as possible after that date.

Personal Details (please complete all fields)

Name
Role/title
Practice (name of practice, type and size)
Email Address
Phone Numbers (please provide your Office and Mobile phone numbers)
Do you have any special requirements?
If you require any special requirements please describe here how we may help and we will contact you
Do you have the full support of your employer to attend this programme? / Employer’s name:
Biographical Information
Length of time in your current role:
Previous role(s) :
Please outline what (if any) continuing professional development you have under taken in the last 3 years?
Please can you outline below an area of development that requires your leadership and which you will be able to develop during the 5 days of the programme, using the tools and techniques that you will learn.
What are your personal objectives in applying for this programme? And how will you know if you have achieved your objectives?
Will you be undertaking any other educational programmes during this programme? If so please provide details.
Please write below any further information that you feel is relevant.
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 secure and confirm a place on this programme and fail to attend any element you/ your employer/ organisation will be charged £2000 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: