Programme Application Form

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Part 1 - Main Applicant

Your Name
Professional Registration
Home Postal Address
Personal Details
Professional and Higher Education - (click 'Add Another Response' to add multiple)
Date Commenced
Date Completed
Special Requirements
How did you hear about our grant programme?

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 - Project Proposal

Why this project is needed and what issues will it address? (300 words)
What will your project aim to achieve? (150 words)
How will you implement your project? (300 words)
What is the expected timeline for the project and will you complete within the 6 month timeframe? (150 words)
Which stakeholder groups will be influenced by or involved in the project, describe how you will work with them, what they will contribute and how they will benefit. Outline how you will make use of diverse media (including social media) to consult, share and inform. (150 words)
What outputs will you produce to demonstrate the impact of your project? Consider creative methods which will have most impact. (150 words)
How will you sustain the outcome/outputs of your project, within your own Association and share what you have learnt with other Associates/Stakeholders? (150 words)
(300 words)
(300 words)
(300 words)
(300 words)

Part 4 - 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 5 - Diversity

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 6 - Supporting Information

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

Part 7 - Nominator references and signature

We require information from a nominator.

Please download the nominator form which is 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 Small Grant Agreement

Please complete and confirm your intention to apply for a small grant by ticking and signing this Small Grant Agreement.

Failure to complete this agreement in time will result in presumption you do not wish to apply for a Florence Nightingale Foundation small grant.

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 a supporting reference signed by a person in a position to verify your suitability to receive the funding and the contribution the grant will make to forwarding the Association aims.
  2. All applicants must be leading an International Nursing Association which is registered as a charity or limited company in the UK.
  3. All applicants must be able to provide details of a UK bank account registered in the name of the Association.
  4. At the end of the 6 month project timeframe, applicants must provide evidence of funds spent from the project budget within 30 days. Any underspend must be returned to the Florence Nightingale Foundation within 30 working days.
  5. I give permission for my details to be passed to the Florence Nightingale Foundation subcommittees as requested.
  6. 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.
  7. 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

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-

'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.