Leadership Support and Development Programme by yCtutf

VIEWS: 5 PAGES: 9

									                 Leadership Support and Development Programme
                                Application form

1.    Personal facts
Date ......................................................................................................................................................
Full name ..............................................................................................           DOB ..................................
Current position/title ..............................................................................................................................
Department/institution ...........................................................................................................................
Telephone numbers: (Landline) ...................................                         (Mobile) ......................................................
Areas of research interest .....................................................................................................................
How did you hear about the NIHR Leadership Programme?
..............................................................................................................................................................
..............................................................................................................................................................



2.    Professional facts

      2.1................................................................................................................................................... .
             NIHR awards or grants

                                                                           Your role
            Title of the project                                                                                       Dates                  Value
                                                                      (PI, co-applicant)




                                                                                                                                                           1
To apply, please send this completed application form, along with an endorsement from a senior
research leader by Monday 20 April 2012, 12:00 noon to:

Juliet Fulcher at juliet.fulcher@ashridge.org.uk




We will let you know whether your application has been successful no later than Thursday 27
April 2012, 17:00.




                                                                                                 2
      2.2      Other major grants during the last 5 years

                                                            Your role
       Title of the project                                                                      Funder                Dates               Value
                                                       (PI, co-applicant)




      2.3      Name of your sponsoring research leader and his/her position/titles
Name ....................................................................................................................................................
Position .................................................................................................................................................




      2.4      Name of any mentor(s) and their positions/titles
Name .................................................................       Position ..................................................................
Name .................................................................       Position ..................................................................




                                                                                                                                                       3
      2.5. How many people do you have direct line management responsibility for?


..............................................................................................................................................................



What are their roles/titles?
• ............................................................................................................................................................
• ............................................................................................................................................................
• ............................................................................................................................................................
• ............................................................................................................................................................
• ............................................................................................................................................................
• ............................................................................................................................................................




Are there other people you have indirect leadership responsibility for? How many? What is their
relationship to you? (For example, they could be part of a network or project which you lead.)
• ............................................................................................................................................................
• ............................................................................................................................................................
• ............................................................................................................................................................
• ............................................................................................................................................................
• ............................................................................................................................................................
• ............................................................................................................................................................




3.    Getting to know you
In this section, we are interested in getting to know you, not in ‘right answers’. We want to
understand if this programme is appropriate for you and to what extent your participation will support
the achievement of the NIHR goals. We hope you take a moment to reflect on your own
development and that you find that reflection valuable.


Please write a maximum of 200 words in response to each question. Thank you.
                                                                                                                                                           4
What are you leading on behalf of NIHR/your institution/other?
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................


What leadership opportunities and challenges do you face?
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................

                                                                                                                                                           5
..............................................................................................................................................................


What difference do you want to make within NIHR and/or health research?
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................


Why are you applying for this Leadership programme now? What is happening that makes this a
good moment to seek development?
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................

                                                                                                                                                           6
..............................................................................................................................................................


Please describe a recent leadership experience that you found exhilarating or challenging. What have
you learnt from it about yourself and about your team and/or organisation?
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................


What questions do you have about your own capacity to lead?
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................


                                                                                                                                                           7
..............................................................................................................................................................


What do you want to get better at, or what do you want to stop or do less of, as a result of your
participation in this programme?
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................


Any other comments
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................


                                                                                                                                                           8
..............................................................................................................................................................




                                                                                                                                                           9

								
To top