Online Leadership Programme Application Form

Programme

PLEASE NOTE: This form requires you to upload images and documents and many firewalls and NHS computers and laptops will not allow this. When completing this form, it is advised that you use your own personal computer and home wifi when completing this form, when possible. Thank you.

Programme *

Do you work for NHS England? *

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Your Details

Title *

If there is not a suitable option please select "Other".

Name *

First

Last

Previous Last Name

If you are known by a previous last name please enter your previous last name here.

Email Address *

Confirm Email

Alternative Email Address *

Confirm Email

If you don't have an alternative email address just enter your email address again.

Home Phone

Please make sure there are no spaces in your phone number. This can sometimes prevent your application from being submitted.

Mobile *

Please make sure there are no spaces in your phone number. This can sometimes prevent your application from being submitted.

Date of Birth *

Twitter Handle

LinkedIn Profile

Home Address *

Street Address

Town/City

County/State

Postal/Zip Code

Country of Residence *

If there is not a suitable option please select "Other".

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Employing Organisation Details

Employing Organisation *

Please enter the full name of your organisation and try to avoid using any acronyms where possible.

Work Address *

Street Address

Town/City

County/State

Postal/Zip Code

Work Country *

If there is not a suitable option please select "Other".

Work Phone *

Please make sure there are no spaces in your phone number. This can sometimes prevent your application from being submitted.

Work Mobile *

Please make sure there are no spaces in your phone number. This can sometimes prevent your application from being submitted.

Work Email Address *

Confirm Email

If you don't have a work email address just enter your email address again

Biography

In order to stimulate the networking process for participants, we ask that you send us a short biography.

Biography *

Please note: Biographies may be edited for consistency and style. Include information on your current and previous roles and interests. Write in the third person. Clarify any abbreviations used.

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Diversity

We are keen to develop diversity in all areas. By completing this section you are helping us to build a picture of those attending our sessions. The information collected is stored in our database and not shared with any third parties.

Age Group

Gender *

If there is not a suitable option please select "Prefer to Self-describe".

Is your gender identity the same as the sex you were registered at birth? *

Yes
No
Prefer Not to Say

Ethnicity *

If there is not a suitable option please select "Other" or "Unknown".

Nationality *

If there is not a suitable option please select "Other".

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Terms and Conditions

We would like to keep you informed about the vital work we do at the Foundation including events, marketing, fundraising and newsletters and we would like you to engage with other scholars.

We will never sell your data and we promise to keep your details safe and secure. You can change your mind at any time by emailing [email protected].

'We’ includes the Florence Nightingale Foundation only.

Would you like to receive communications from Florence Nightingale Foundation? *

YES, I would like to receive communications from Florence Nightingale Foundation
NO, I do not wish to receive communications from Florence Nightingale Foundation

Please tick the boxes below to tell us all the ways you would prefer to hear from us:

I would like to receive communications by EMAIL

I would like to receive communications by PHONE

I would like to receive communications by PHONE

I would like to receive communications by POST

I would like to receive communications by POST

Data Consent *

I AGREE for my details and data to be stored and maintained on Salesforce, a secure platform used by the Florence Nightingale Foundation

GDPR: means (i) unless and until the GDPR is no longer directly applicable in the UK, the General Data Protection Regulation, Regulation 2016/679/EU, and any national implementing laws, regulations and secondary legislation, as amended or updated from time to time, in the UK and then (ii) any successor legislation to the GDPR or the Data Protection Act 1998.

Please read our privacy policy here on how we manage our data.

Terms and Conditions *

I AGREE to all the terms and conditions and I consent to my data being shared with carefully selected parties as part of the application process

Cancellation Policy
As a not-for-profit organisation it is crucial that Florence Nightingale Foundation recover any programme costs in the event of a participant cancellation. Therefore, by accepting a place on this programme I will commit to attend all programme days.

Florence
Nightingale
Foundation

Programme

Your Details

Job Details

Qualifications

Employing Organisation Details

Biography

Diversity

Special Requirements

Programme Administration

Terms and Conditions

FlorenceNightingale Foundation