Mary Seacole Application Form

Mary Seacole programme application form 2025

We would recommended you click ‘Save and Continue Later’ button to avoid your application being lost as you proceed through the questions.

1Privacy Agreement

2About you

3Cohort

4Employment Information

5Funding

6Equality, Diversity & Inclusion

7Personal Statement

8Keeping in touch

9Terms and Conditions

10Summary

Application-ID
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Submission Date
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Privacy Agreement

Any information you provide in completing this application will be stored and processed in accordance with our Data Privacy Policy which you are required to read and accept before completing your application.

By proceeding with this application, you agree that The Leadership Academy may contact you if you have partially completed your application to offer guidance and support with finishing your application.
This is a separate agreement to the marketing preferences selected further in this application.
Please check the box below to accept the above agreement and our Data Privacy Policy(Required)
I confirm I have read and accept the Academy’s Data Privacy Policy and above agreement

Please note this form is closed and applications will not be counted
About you
Name(Required)
First Last
Preferred Name
Preferred Email(Required)

Your primary email address
Preferred contact number(Required)
Your main contact number with international dialling code and extension if necessary
Date of Birth
DD dash MM dash YYYY
Please enter your 10-digit Academy ID(Required)

If you already have an Academy ID, please log on to our new Academy Profile system using your existing log in details to ensure your account is transferred to our new system.
If you need help remembering your existing Academy ID, please use the Reset password feature on the Profile system.
If you do not have an Academy ID, please register on our Academy Profile system to create one.
Home address
Street Address Address Line 2 City ZIP / Postal Code Country
Region(Required)

Employment Information
Please enter the details of your current main job role.
Organisation Region(Required)
Country(Required)
Please select your country
Organisation Name(Required)

The name of your organisation

Primary Role The primary role of your organisation

Postcode
The postcode of your organisation
Is this an NHS organisation?(Required)

Yes

No
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Organisation
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Organisation Type
Please enter the type of organisation
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New Organisation
Hidden section that is only shown when the organisation is unknown
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Organisation Name
Please enter the name of the organisation
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Organisation Post Code
Please enter the post code of the organisation
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Does this organisation provide any NHS-funded care?(Required)

Yes

No

Don’t know
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Role(Required)
Area of work(Required)
Job Title(Required)
Please enter your job title
Salary/Band(Required)
Current?(Required)

Yes

No
Are you currently active in this role? Please note: we only require past roles if you are unemployed.
Number of years within your role(Required)
Number of years working in the UK(Required)
Which of the funded places are you applying for?(Required)

Funding

If you are part of a commissioned or local cohort, then you are not required to complete this section. Please feel free to continue by clicking next below.
Funding

You are applying for a place that is fully funded by NHS England and Improvement as part of the Growing Occupational Health programme
Funding
The Mary Seacole programme costs £995 per person. The cost is fully inclusive of the three virtual workshops and access to the virtual campus.

If you intend for your organisation to fund your place on this programme, please do not continue with this application unless funding has been secured in agreement with your line manager.
How will your place on the programme be funded?(Required)
Please indicate the method you will use to fund your place on the programme. If you are sharing the cost with your organisation then choose the second option as you will be responsible for obtaining the funds from your organisation. Please check with your line manager or finance team if you are unsure how your place will be funded. Please check with your line manager or finance team if you are unsure how your place will be funded.

An organisation will be funding my place

I will be funding my place
Does this organisation provide NHS funded care?(Required)

Yes

No
Internal Transfer?
Yes
Check this box if your organisation is eligible to pay by direct internal cost-centre transfer rather than invoice. If in doubt, leave this box unchecked and we will invoice you.
Budget holder email address(Required)
If you are being funded by your organisation please note the email address of your budget holder (or other authorised person) above. If you are self-funding please note your main email address used in the ‘about you’ section.

Equality & Diversity
We hold the principles of equality and inclusion at the heart of everything we do and all that we stand for. Each programme is held to account for its inclusion practice through a review of anonymised statistics based on this data. Your equality and diversity data is not used to determine the success of your application. This data is stored securely in compliance with the General Data Protection Regulation (GDPR) 2016.
Which of the following best describes your gender?(Required)
Are you now or have you ever defined yourself as Trans?(Required)
Which of the following best describes your sexual orientation?(Required)
Which of the following best describes your ethnic background?(Required)
Which of the following best describes your religion or belief system?(Required)
Which of the following best describes your nationality?(Required)
Do you consider yourself to have a disability?(Required)
Many people do not consider themselves to be disabled. However under the Disability Discrimination Act 1995 and the Equality Act 2010, you are protected from discrimination if you have a physical or mental impairment or long term health condition, the effects are expected to last – or have lasted – for a year or longer and have a substantial impact on your ability to carry out day to day activities; or your day to day activities would be limited without medication, treatment or adjustments (for example the use of inhalers, physiotherapy, a hearing or visual aid or insulin). Taking this into account, do you consider yourself to have a disability?
About your disability

Personal Statement

If you are part of a commissioned or local cohort, then you are not required to complete this section. Please feel free to continue by clicking next below.
Personal Statement

You are applying for a place that is fully funded by NHS England and Improvement as part of the Growing Occupational Health programme. Use the following space to outline why this programme is right for you as an OH leader, how you will use the learning, and what you will give back to OH, and NHS services in return for this fully funded place.
Personal Statement
Your Personal Statement(Required)
Your personal statement is an important part of your application, and should explain why you’re interested in studying on this programme, your relevant experience, and provide a clear argument for why you should have a place. It should be no more than 500 words ± 10%. To support us in reviewing your application for suitability and eligibility, we’d strongly encourage you to make full use of the word count.

This programme leads to a NHS Leadership Academy Award in Healthcare Leadership.

Your statement should answer the following questions:
- 1. Why should I have a place on this programme? And why now?
- 2. What is my relevant professional and leadership experience?
- 3. Tell us about your current role and the people you lead.
- 4. Tell us how you plan to meet the requirements for 4 hours of study per week.
- 5. What support will your line manager/organisation provide for you while you’re on the programme?
(500 words)
Your Personal Statement – PT(Required)
Your personal statement is an important part of your application, and should explain why you’re interested in studying on this programme, your relevant experience, and provide a clear argument for why you should have a place. It should be no more than 1000 words ± 10%. To support us in reviewing your application for suitability and eligibility, we’d strongly encourage you to make full use of the word count.

This programme leads to a NHS Leadership Academy Award in Healthcare Leadership.

Your statement should answer the following questions:
- 1. Tell us about your current role and the people/projects/kind of work you lead, demonstrating the complexities and challenges. (250 Words)
- 2. Tell us what you hope to be able to bring to the programme and how you’ll use your learning to help make a positive impact for both staff and patients/service users. (200 Words)
- 3. Why have you chosen this programme, why now, and what do you hope to achieve? (200 Words)
- 4. What are you passionate about, and hoping this programme will help you address, in your work place? (250 Words)
- 5. What arrangements will you make to create time to study for at least 15-20 hours a month? (100 Words)

Terms and Conditions
1. I confirm that all the information provided in the application form is up to date and accurate.

2. If I am from outside the EU and working in England with a visa; I confirm my UK visa and immigration clearance covers study as well as work.

3. I have full practical, and financial (if organisation funded), support in place from my manager and organisation for me to commit to all aspects of learning during the full duration of the programme. They have agreed to make the necessary workplace arrangements and allow me time away from work in order for me to attend all of the virtual and/or face to face elements.

4. I will attend and partake in all the face-to-face workshops and all the learning activity associated with the programme, including all the assignments regardless of the amount of study leave I am granted. Not attending the programme without agreeing extenuating circumstances with the NHS Leadership Academy could mean that I may lose my place on the programme.

5. I understand that all the elements of the programme are compulsory and attendance is part of the assessment, pass mark, and NHS Leadership Academy accreditation. I understand that the assessment criteria are as follows:

a) Completion of all online work through the Virtual Campus

b) Mandatory attendance at all three workshops

c) Contributions to online discussions

d) Submission of a 2,000 word impact written assignment.

6. I understand that the programme is designed around practical learning in the workplace – the most important environment for me to learn and develop as a leader – and that I will not be able to complete the programme without application in my workplace. I understand there is an extenuating circumstances policy in place if I struggle to apply the learning in the workplace, which is provided once the programme commences.

7. I acknowledge that I cannot defer on this programme.

8. The amount of paid or unpaid study leave I receive (in addition to the time away from work for the face to face elements of the programme) will be determined by the relevant policy of or by the management of my employing organisation.

9. I understand that my travel costs and subsistence (other than lunches during the face-to-face days if relevant) are not covered by the fees for the programme and my employing organisation’s expenses policy will apply.

10. I understand that if I move jobs during the programme:

a) This does not automatically constitute extenuating circumstances for withdrawal from the programme; and

b) I will make my new employer and line manager aware before I accept the job offer that I am committed to complete the programme and will require their support to do so.

11. If I am self-funding, if, having accepted a place, I either fail to start or fail to complete the programme for any reason whatsoever (other than for a reason that the NHS Leadership Academy in its absolute discretion determines is an extenuating circumstance), I will remain liable to still pay the programme fee and the fee will not be refunded.
Please check the box below to accept our Terms and Conditions(Required)
I agree to the Terms and Conditions

Problems?

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Privacy Agreement

Please note this form is closed and applications will not be counted

About you

Cohort

There are currently no cohorts available

Cohort

West Mids Cohort

CandP

Cohort 15

Lancashire and South Cumbria

Cheshire and Mersey

London Licence

Greater Manchester Cohort

South Warwickshire Cohort 31

Lincolnshire Cohort

Leeds Teaching Hospitals Cohort

South East Cohort

Employment Information

New Organisation

Funding

Funding

Funding

Equality & Diversity

Personal Statement

Personal Statement

Personal Statement

Keeping in touch

Terms and Conditions

Summary

Problems?