Enrol – Edward Jenner programme v2.1

1Privacy Agreement

2Contact Details

3Job Role

4Equality & Diversity

5Agreement

6Summary

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.
Please check the box below to accept our Data Privacy Policy*
I confirm I have read and accept the Academy’s Data Privacy Policy

Job Role
Please enter the details of your current main job role.
Organisation*
Country*
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Organisation Type*

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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
Does this organisation provide any NHS-funded care?*

Yes

No

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Role*
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.

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?*
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?
Which of the following best describes your ethnic background?*
Which of the following best describes your religion or belief system?*

Agreement
Please check the box below to accept our Terms and Conditions*
Edward Jenner programme (v2.1) – Terms and Conditions of enrollment

Last updated: 2 September 2020

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

2. If I am from outside the EU and working in England with a visa; I confirm my UK visa and immigration clearance covers study as well as work.

3. 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 engage with the programme.

4. I will partake in all the learning activity associated with the programme, including all the assignments regardless of the amount of study leave I am granted.

5. I understand that all the elements of the programme are compulsory and engagement is part of the requirements for completion and NHS Leadership Academy accreditation. I understand that the assessment criteria are as follows:

a) Completion of all online work

b) Contributions to online discussions

c) Submission of a written ‘Leadership Difference story’ (a written reflective learning and impact assessment)

6. I understand that the programme is designed around practical learning in the workplace / on placement – 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 / placement. 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.

7. I acknowledge that I cannot defer on this programme.

8. 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.

9. I understand that no travel costs and subsistence are covered by the programme and my employing organisation’s expenses policy will apply for any incidentals incurred while engaging with learning on this programme.

10. 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.

I agree to the Terms and Conditions

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Privacy Agreement

Contact Details

Job Role

New Organisation

Equality & Diversity

Agreement

Edward Jenner programme (v2.1) – Terms and Conditions of enrollment

Summary

Alert: Edward Jenner 2.1 Retirement