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Application FormSystem OD and Change Consulting Skills: A Programme for Change LeadersPlease note, the programme will comprise of 4 workshop days which will take place in the North West region. You will be required to attend all sessions. Please ensure you are able to commit to all programme dates before submitting your application, and hold the workshop dates in your diary during the application period, to ensure you are available if your place is confirmed; Monday 11th March 2019Tuesday 30th April 2019Tuesday 11th June 2019Thursday 18th July 2019Please answer all the questions below: Personal DetailsNameJob titleOrganisationTelMobileEmailOrganisational/System Sponsor Sponsor nameRoleOrganisationRelationship to applicantTelEmailApplication Please write up to 400 words. Describe your reasons for applying, your aims and objectives, and what you hope to achieve from taking part in the programmePlease write up to 400 words. Describe your experience as a leader of change/OD/HR/transformation leader Please write up to 400 words. Identify a specific system change project/workstream to which you can apply the learning from this programmePlease write up to 400 words. Describe specifically how you intend to apply the learning gained during this programme in your current mitment and ConsentPlease confirm your commitment to attendance and participation requirements of the programme.This programme is funded by the NHS Leadership Academy. If you are successful in gaining a place on this programme you will need to commit to the following:Attendance at all 4 days of the workshop dates and undertaking 2 coaching sessions between modulesComplete any pre-programme activities as requested by the providerParticipate in programme evaluation activities; complete and return any pre and post-programme evaluation questionnaires and participate in any post-programme follow up, especially to evaluate long term impact.Signature I confirm my commitment to attend all listed programme dates and to fully participate on the programme and in evaluation:Date Thank you for completing this form. Please return to @ by 5pm on Wednesday 6th February 2019Application does not guarantee a place. ................
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