Application Form – Bevan Application Form

Application-ID
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Submission Date
DD dash MM dash YYYY
Privacy Agreement

Any information you provide in completing this application will be stored and processed in accordance with our Data Privacy Policy which you are required to read and accept before completing your application.

By proceeding with this application, you agree that The Leadership Academy may contact you if you have partially completed your application to offer guidance and support with finishing your application.
This is a separate agreement to the marketing preferences selected further in this application.
Please check the box below to accept the above agreement and our Data Privacy Policy*
I confirm I have read and accept the Academy’s Data Privacy Policy and above agreement.

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About you
Name*
First Last
Preferred Name
Preferred Email*

Your primary email address
Preferred contact number*

Your main contact number with international dialling code and extension if necessary
Date of Birth*
DD dash MM dash YYYY
Please enter your 10-digit Academy ID*

If you already have an Academy ID, please log on to our new Academy Profile system using your existing log in details to ensure your account is transferred to our new system.

If you need help remembering your existing Academy ID, please use the Reset password feature on the Profile system.

If you do not have an Academy ID, please register on our Academy Profile system to create one.
Home address*
Street Address Address Line 2 City ZIP / Postal Code Country
Region*

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Cohort

Please note Nye Bevan cohorts will be commencing in January 2023.

Further specifics including the dates of residentials and your cohort preference will be discussed with successful applicants at a later date.
Preferred Cohort*

Cohort 37

Cohort 38
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Admin Note:
Unique field to Bevan; values taken from https://nhsx.uk/admin/programmes/nye-bevan-programme-9855/applications/393/fields/18619/edit
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Preferred Assessment interview location

Leeds

London

Birmingham

No preference

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Employment Information
Please enter the details of your current main job role.
Organisation*
Country*
Please select your country
Organisation Type*

Please enter the type of organisation
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New Organisation
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Organisation Name*

Please enter the name of the organisation
Organisation Post Code*

Please enter the post code of the organisation
Is this an NHS organisation?*

Yes

No
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Does this organisation provide any NHS-funded care?*

Yes

No

Don't know
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Organisation Region*
Role*
Area of work*
Job Title*

Please enter your job title
Salary/Band*
Current?*

Yes

No
Are you currently active in this role? Please note: we only require past roles if you are unemployed.
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Admin Note: Line Manager
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Line Manager Name
First Last
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Line Manager Job title
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Line Manager Email
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Line Manager Phone

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Educational Attainment
Highest academic attainment
Date of highest academic attainment
MM slash DD slash YYYY
Highest qualification course name

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Bursary & Funding
The Nye Bevan programme costs £4,500 per person.
Bursary*
Before answering the below question, please ensure you have read the bursary eligibility requirements available on the Leadership Academy website at https://www.leadershipacademy.nhs.uk/programmes/bursary-information/

I can confirm I have read the bursary information and would like to apply for a bursary to fund the programme:

Yes, I am eligible and would be interested in applying for a bursary

No, I would not be interested in applying for a bursary
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Bursary Application Process
A member of the Nye Bevan Programme team will be in touch with the bursary application form in due course.
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Admin Note (Bursary):
Below is additional question for Anderson and Bevan only.

Wording and link to website copied from Bevan application form on NHSx.
Bursary Statement*
The inclusion bursary scheme exists to promote greater representation of underrepresented groups to tackle a lacking of diversity evidenced in more senior positions across the NHS.

Please can you describe some of the ways that the existence of inequality within the NHS or beyond may have impacted on either your career development or your day-to-day lived experience within the NHS. What could be done to make improvements in this area? (max: 500 words).

Full information and guidance surrounding the bursary scheme can be found in your application guide, and is available on the bursary information page of our website.

Please take care to make use of the word count provided to talk about your personal circumstance and reasons why you feel that you should be awarded a bursary. As mentioned in the guidance notes, your bursary application will be reviewed in isolation from your programme application so that any information you feel relevant should be included in both.

Please leave this blank if you’re not applying for a bursary.
How will your place on the programme be funded?*Please indicate the method you will use to fund your place on the programme. If you are sharing the cost with your organisation then choose the second option as you will be responsible for obtaining the funds from your organisation. Please check with your line manager or finance team if you are unsure how your place will be funded.

An organisation will be funding my place

I will be funding my place

I have applied for a bursary above
Does this organisation provide NHS funded care?*

Yes

No
Internal Transfer?
Yes
Check this box if your organisation is eligible to pay by direct internal cost-centre transfer rather than invoice. If in doubt, leave this box unchecked and we will invoice you.
Budget holder email address*

If you are being funded by your organisation please note the email address of your budget holder (or other authorised person) above. If you are self-funding please note your main email address used in the 'about you' section.
Line manager email address*

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Equality & Diversity
We hold the principles of equality and inclusion at the heart of everything we do and all that we stand for. Each programme is held to account for its inclusion practice through a review of anonymised statistics based on this data. Your equality and diversity data is not used to determine the success of your application. This data is stored securely in compliance with the General Data Protection Regulation (GDPR) 2016.
Which of the following best describes your gender?*
Are you now or have you ever defined yourself as Trans?*
Which of the following best describes your sexual orientation?*
Which of the following best describes your ethnic background?*
Which of the following best describes your religion or belief system?*
Which of the following best describes your nationality?*
Do you consider yourself to have a disability?*
Many people do not consider themselves to be disabled. However under the Disability Discrimination Act 1995 and the Equality Act 2010, you are protected from discrimination if you have a physical or mental impairment or long term health condition, the effects are expected to last – or have lasted – for a year or longer and have a substantial impact on your ability to carry out day to day activities; or your day to day activities would be limited without medication, treatment or adjustments (for example the use of inhalers, physiotherapy, a hearing or visual aid or insulin). Taking this into account, do you consider yourself to have a disability?
About your disability
Do you consider yourself to have a Learning Difficulty?

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Personal Statement
Your Personal Statement*
Your personal statement is an important part of your application, and should explain why you’re interested in studying on this programme, your relevant experience, and provide a clear argument for why you should have a place. It should be no more than 1000 words ± 10%. To support us in reviewing your application for suitability and eligibility, we’d strongly encourage you to make full use of the word count.

Your statement should answer the following questions:
- 1. Why have you chosen to apply to the Nye Bevan programme, why now, and what do you hope to achieve through participating on the programme?
- 2. What is my relevant experience and my aspiration to move into an executive director or equivalent role?
- 3. Tell us what you hope to bring to the programme and how you’ll use your learning to make a positive impact for patients/service users, your team/staff and your organisation?
- 4. What arrangements will you make to create time to study for at least 15 hours a week? (You should give consideration to the time required for residential workshops, learning sets, writing assignments, the practical application of your learning to the workplace and where applicable the additional learning elements.)
- 5. What support will your line manager/organisation provide for you whilst you are on the programme? Please give consideration to the different aspects of the programme (outlined in question 4) in your discussions with your line manager
(1000 words)
The Long-Term Plan*
How and when have you developed a strategy that will sustainably deliver against the ambitions of the Long-Term Plan?
(300 words)
Personal Actions*
What personal actions demonstrate that you not only respect diversity and inclusion, but that you also take action against racism, discrimination and bullying?
(300 words)

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Keeping in touch

We'd like to keep in touch with you on updates about our products, services, promotions, news and events. Please select your preferences to help us keep you up-to-date
Where did you hear about the programme?
Would you like to receive updates from the Leadership Academy about other programmes on offer?
Would you like to receive updates from the Leadership Academy about other learning opportunities such as bite size learning, mentoring, news and events?
Would you be happy to be contacted by the Academy for research purposes?
(Your views are important to us and help us grow).
At the moment updates are delivered via email but we are exploring options to communicate via mobile, would you be happy to receive notifications from us via mobile in the future?

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Terms and Conditions
Nye Bevan

The applicant confirms that:

1. Any information you provide in completing this application will be stored and processed in accordance with our Data Privacy Policy which you are required to read and accept before completing your application https://www.leadershipacademy.nhs.uk/privacy/

2. I confirm that all the information provided in the application form is up to date and accurate.

3. I have read the applicant guide and have full practical, and financial (if organisation funded), support in place from my manager and organisation for me to commit to all aspects of learning during the full duration of the programme. I understand that these terms and conditions come into force once my place on the programme has been confirmed, and if I subsequently either fail to start or withdraw from the programme, the organisation or individual responsible for funding my place will remain liable for the full programme fee of £4,500. Any fees paid once I have commenced on the programme are non-refundable.

4. I understand that the programme is designed around practical learning in the workplace –the most important environment for me to learn and develop as a leader – and that I will not be able to complete the programme without application in my workplace. I understand there is an extenuating circumstances policy in place if I struggle to apply the learning in the workplace, which is provided once the programme commences.

5. I will attend and partake in all the face-to-face / virtual workshops and all the learning activity associated with the programme, including all the assignments regardless of the amount of study leave I am granted. Not attending the programme without agreeing extenuating circumstances with the NHS Leadership Academy could mean that I may lose my place on the programme.

6. I acknowledge that the NHS Leadership Academy does not routinely defer places, and a request to defer my place will only be considered in very exceptional circumstances.

7. I Understand that all elements of the programme are compulsory, and attendance is part of the assessment, pass mark, and NHS Leadership Academy accreditation. I understand that the assessment criteria are as follows: a) Completion of all online work through the Virtual Campus b) Mandatory attendance at all four residentials and learning sets c) Submission of three written element assignments.

8. I have the full support of my line manager to take part in the programme and they have agreed on behalf of my organisation, to make the necessary workplace arrangements and allow me time away from work in order for me to attend all of the face-to-face elements. I agree that standard communication regarding my attendance in the programme will be copied to my line manager.

9. I understand that there may be audio recording, filming and photography of me taken whilst on the programme. I agree that the NHS Leadership Academy may use photographs, film, audio and video recordings of me made during the programme to showcase the programme including promoting it in the NHS, to Central Government, and to the public via the NHS Leadership Academy’s website or other media.

10. To receive the Nye Bevan NHS Leadership Academy award in Senior Healthcare Leadership, I will submit a piece of work set by the Acacdemy. By submitting this I am confirming that my submission is my own work and I accept all responsibility for any copyright infringement that may occur as a result of this submission. I am aware this material will enter the public domain, be shared across my cohort, and have provided no personally identifiable information about colleagues or patients that have not previously provided me with written consent.

11. The programme fee will cover the cost of accommodation and lunch for the residential events when offered as face-to-face delivery. Travel costs are not covered.

12. I understand that if I move jobs during the programme:
A) This does not automatically constitute extenuating circumstances for withdrawal from the programme; and
B) I will make my new employer and line manager aware before I accept the job offer that I am committed to complete the programme and will require their support to do so.

13. The amount of paid or unpaid study leave I receive (in addition to the time away from work for the face to face elements of the programme) will be determined by the relevant policy of or by the management of my employing organisation.

14. If I am from outside the UK working in England with a Visa, I confirm my UK Visa and immigration clearance covers study as well as work for the full duration of the programme and I can provide proof of this.

15. If I am self-funding, if, having accepted a place, I understand I will be invoiced automatically using the details I have given on my application. If I either fail to start or fail to complete the programme for any reason whatsoever (other than for a reason that the NHS Leadership Academy in its absolute discretion determines is an extenuating circumstance), I will remain liable to still pay the programme fee and the fee will not be refunded.

16. If my organisation is funding my place on the programme, I will submit a Purchase Order or my Internal Transfer details before the programme starts and by the deadline as stated in the offer email.

17. Failure to secure payment for participation on the programme will be reviewed by programme leads and will result in my removal of access to the course materials, virtual campus and workshops.
Please check the box below to accept our Terms and Conditions*
I agree to the Terms and Conditions

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Summary
Please check your details and, if correct, submit this form.
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Save and Continue Later

Privacy Agreement

About you

Cohort

Admin Note:

Employment Information

New Organisation

Admin Note: Line Manager

Line Manager Details

Educational Attainment

Bursary & Funding

Bursary Application Process

Admin Note (Bursary):

Equality & Diversity

Personal Statement

Keeping in touch

Terms and Conditions

Nye Bevan

Summary

Problems?