Florence Nightingale Foundation Leadership Scholarship Application Form

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Part 1 - Personal details


Your Name
Professional Registration
Home Postal Address
Personal Details
DD/MM/YYYY
Professional and Higher Education - click 'Add another response' to add multiple
Date Commenced
Date Completed
Emergency Contact Details
Special Requirements
How did you hear about our scholarships?

Part 2 - Employment details

Job Title
Please write in full without abbreviations
If you are not employed by the NHS please input the band that your salary equates to
Employing Organisation Details
Please write in full without abbreviations (e.g. GSTT)
Please write in full without abbreviations (e.g. GSTT)
Work Contact Details

Part 3 - Supporting information

Nominator Details - Chief Nurse or Director of Nursing
Nominator Details - Key Line Manager
Organisation Information

Part 4 - Personal leadership

Briefly outline your current role, highlighting any specific operational and strategic responsibilities

Part 5 - Programme administration

Please note: Biographies and answers will 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.
Headshot instructions: head and shoulders only. This photo will be used for your records and will accompany your biography where appropriate.

Part 6 - Diversity form

We are keen to develop diversity in all areas. By completing this form you are helping us to build a picture of those applying and attending our programmes. The information collected is stored in our database and not shared with any third parties. Your responses to this section will not be visible to decision makers during the application process.

Part 7 - Nominator references and signature

We require information from 2 nominators.

Please download the nominator forms via the following links which are to be filled in by your Chief Nurse or Director of Nursing and your immediate line manager.

Please rename your nominator form prior to upload to include the applicant's NMC registration number and name e.g. 'Nominator form - John Smith 12345'

Please note forms are to be filled out electronically. Hand-written submissions will not be accepted.

Part 8 - Terms and conditions


Florence Nightingale Foundation Scholarship Application Agreement

Please complete and confirm this is your intention to apply for a scholarship by
ticking and signing this Scholarship Application Agreement.

Failure to complete this agreement in time will result in presumption you do not wish
to apply for a Florence Nightingale Scholarship or no longer require a place on the
leadership programme.

By signing this page I acknowledge and agree to the following terms and conditions:
  1. All applications submitted for the selection process must be accompanied by this completed application form and 2 completed nominator forms signed by my Chief Nurse or Director of Nursing and my line manager giving approval for the release of time to attend all programme dates and to commit to the payment of the 10% employer contribution
  2. All dates are mandatory. By applying for a place on this scholarship programme I commit to attend all programme days. I agree to partake fully and engage with the programme in its entirety, acknowledging the dates provided are compulsory.
  3. I understand I will be notified of the result of my application 20 working days after the application closing date.
  4. I will become a member of the Florence Nightingale Foundation Alumni Community on completion of the scholarship and will support future, current and past scholars within my area of expertise.
  5. I give permission for my details to be passed to the Florence Nightingale Foundation subcommittees as requested.
  6. If I have a period of sickness or any event that may impact on my ability to attend the Interview I will inform the Foundation as soon as possible to negotiate a new arrangement (subject to availability of dates)
  7. I understand Florence Nightingale Foundation holds all participants' application details in confidence and in line with the requirements of the Data Protection Act 1998 to ensure GDPR compliance.
  8. I give my consent for information and/or images/photographs ("Information") about myself to appear in associated publications from the Foundation.

GDPR* Data Management Statement

We would like to keep in touch with you about the vital work we do at the Foundation
including events 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 admin@florence-nightingale-
foundation.org.uk

'We’ includes the Florence Nightingale Foundation only.

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


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.