Apply for the CVD Academy

Section 1: About you

Name: *

Prefix First Last

Job title: *

Name and address of GP practice: *

PCN: *

ICS *

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)

Section 2: Your knowledge and experience in implementing change

Please answer the following questions demonstrating your understanding, knowledge and skills in the following areas:

See “Information for applicants“

What does implementing an innovation mean to you in the context of primary care delivery? (max. 300 words) *

Please note that we are not looking for a text-book definition, more what implementation means to you in your daily work. If you have an example of implementing an innovation that you have observed or been a part of, please include it here.

How will you ensure you have enough time to dedicate to your project? *

(max 100 words)

Section 3: Motivation for applying

Please tell us why you want to participate in the CVD Academy and what you hope to gain from this programme? *

(max. 300 words)

What changes would you like to see within your practice/PCN that you feel will improve patient care? *

(max. 300 words)

Section 4: About your project

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? *

Section 6: Demographics

Please complete our demographic survey form

Please confirm whether you have completed the form:

Yes

No

Section 7: Organisational support and declaration

Employing organisations are expected to:

Enable individuals to commit to a minimum of 75% of the programme during 2023/24

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

Please note: we may contact your line manager/clinical lead for a reference.

Name of manager/clinical lead: *

Prefix First Last

Position *

Email of manager/clinical lead

Date *

Website

Apply for the CVD Academy

CVD Academy application form

Section 1: About you

Section 2: Your knowledge and experience in implementing change

Section 3: Motivation for applying

Section 4: About your project

Session 5: Programme participation

Section 6: Demographics

Section 7: Organisational support and declaration