Apply for the CVD Academy

Name: *

Prefix First Last

Job title: *

Name and address of GP practice: *

PCN: *

ICS, please select from the drop down list *

Contact number: *

Mobile number preferred

Email address: *

Enter Email Confirm Email

Key responsibilities: *

Please briefly summarise the responsibilities of your current post (100 words max)

Do you have a project that you can work on during the programme? *

Yes, I have a project that I am already working on

Yes, I have a project idea, but I have not started working on it yet

No, I do not have a project idea

Aim statement: What are you trying to accomplish with your project?  *

Why is this project important and how will it impact CVD within your PCN? *

How will you measure impact of this work? *

Please confirm whether you have completed the form:

Yes

No

Employing organisations are expected to:

Enable individuals to commit to a minimum of 75% of the programme during 2025

Ensure that individuals have the opportunity to put into practice what they learn through implementation of a CVD-focused project.

Name of manager/clinical lead: *

Prefix First Last

Position *

Email of manager/clinical lead

Date *

Website

CVD Academy application form