Practitioner Level Coaching Qualification Individual Participant Application Form

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1 Practitioner Level Coaching Qualification Individual Participant Application Form *Name * Role / Job Title: *Band * Organisation: * Address *Telephone: Mobile: * Name and Role of Line Manager: * Line Manager Please Confirm that you have access to: PC, Mac, Laptop, or Table Broadband Connection Browser (Internet Explorer 8 or higher, Google Chrome, Mozilla, Firefox, Apple Safari ) Microphone and Speakers Cookies Enabled

2 Selection Criteria (please enter a Y in each box to confirm) 1. Opportunities to coach within role 2. Strong Line Manager support 3. Ability to build rapport with a diverse range of people at different levels 4. High levels of confidentiality and integrity 5. Track record of seeking and providing feedback 6. Feedback received suggests a coaching style and aptitude 7. Commitment to follow processes and protocols established to support the coaching pool 8. Demonstrated a clear commitment to their personal development and able to give tangible and recent examples of self-driven development activity 9. Able and willing to commit to study and experiential learning time required throughout programme (total learning hours approximately 150 to 200 hours of learning over 7 months) 10. Able and willing to contribute to regular supervision sessions 11. Willing to be coached go through their own coaching journey 12. Experience in range of roles, including at managerial level/with line management responsibility 13. Scope to source and take on 3-4 coachees and meet with each on a regular basis throughout the programme and commitment on an ongoing basis to coach 3-4 coachees across the business at any one time (pro-rata for part-time employees). 14. Available on 12 th January 2015 for the first workshop X Availability for Interview on Monday 7 th or Tuesday 8 th December 2015 at the Institute for Mental Health, University of Nottingham, Jubilee Campus NG7 (approx. 20 mins in duration) Monday 7 th December :00 13:30 09:30 14:00 10:00 14:30 10:30 15:00 11:00 15:30 11:30 16:00 12:00 16:30 12:30 17;00 Tuesday 8 th December :00 13:30 09:30 14:00 10:00 14:30 10:30 15:00 11:00 15:30 11:30 16:00 12:00 16:30 12:30 17;00

3 Please answer the following questions honestly and succinctly, as they will help to determine whether you are likely to be a suitable candidate for the EMCC Practitioner Level Coach Mentoring Qualification programme and whether it s the appropriate time for you: 1. How would you define coaching and mentoring? 2. What opportunities, current or previous have you had to coach or mentor people? 3. What previous coaching and mentoring training have you had? 4. How open are you to being coached yourself? How would you prepare yourself to be coached?

4 5. How would you describe your key values? 6. How do you feel about coaching the person, not the issue and therefore not providing solutions, even when you are convinced you know the answer? 7. What do you believe should be the balance between support and challenge when you are coaching? Give an example of when you have really challenged someone and what impact it had? 8. How comfortable are you to receive feedback from the people you are coaching which will be honest and constructive?

5 9. How have you proactively driven your continuous professional development in the last 24 months? What have your key reflections and learning been in that time? 10. Finally please confirm that you are willing to make the necessary time available approx. 150 to 200 learning hours over 7-9 months. If so, please state what your motivation in making this investment of time is and how you will ensure that you are able to make that time available. Any other comments you would like to add in support of your application.

6 Key Programme Dates: Cohorts Workshop(s) Location Date(s) Cohort 1 Cohorts Launch Day 1 Nottinghamshire 13 th January Telephone Tutorial N/A TBC Skills Webinar 1 Webinar 4 th or 16 th March Skills Webinar 2 Webinar 15 th or 29 th April Skills Webinar 3 Webinar 9 th or 20 th May 360 Healthcare Nottinghamshire 12 th May Leadership Model Facilitator Training Skills Webinar 4 Webinar 14 th or 23 rd June Coaching CPD - Theatre Skills! with Yew Tree Lodge Hotel, Kegworth 3 rd February NLP for Coaches Derbyshire Coaching Supervision TBC TBC It is mandatory that participants can attend all dates within the programme. Skills Webinars will have 2 sessions for each. The Closing date for applications is 17:00 on 20 th November Applications submitted after this time will not be considered. You will be informed of the outcome of your application on 9 th December 2015 Terms, Conditions and Cancellation Policy Important Please Read There is no cost to attend if you are a fully subscribed EMLA member however cancellation fees will apply for non-attendance, the fee will be variable depending on the nature of the cancellation. If a candidate withdraws from the entire programme after attending and enrolling on to the programme and an appropriate substitution cannot be found, then a full cancellation fee of 2,000 may be charged. EMLA does recognise that there may be extenuating circumstances where cancellation or non-attendance on the day may be unavoidable and an appeals procedure is in place to evaluate extenuating circumstances. Our full cancellation policy and terms and conditions can be found here: Please Turnover

7 The applicant I am fully committed to attending and participating in all components of the EMCC Practitioner Level in Coaching Qualification if my application is successful. I realise the importance of full attendance and am available for all the dates listed above. I also agree to supporting the East Midlands Leadership Academy Coaching Pool by delivering 20 hours of coaching per year for 2 years from completion of this programme. YES NO Name Date The line manager / sponsor I fully understand the commitment that is required of the applicant and I am prepared to support them throughout the programme as well as offer help and support when they undertake applied learning and the coaching sessions with their coachees. I have read the cancellation policy outlined at the top of the page and I understand and accept EMLA s terms and conditions in the event of a cancellation by the candidate. YES NO Name Date Name Please return your completed application form via to eastmidlands.leadershipacademy@nottshc.nhs.uk What do I do if I want to know more? To find out more about this exciting opportunity or to discuss your application in more detail then please contact the Programme Coordinator, Pamela Smith-Falls on or Pamela.Smithfalls@nottshc.nhs.uk

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