Application Form
NIHR Leadership Programme for NIHR Trainees
Section 1: Essential Facts
Date:
Title:
First name:
Surname:
Landline:
Mobile (preferred):
Email:
Department and Institution:
Date Awarded PhD:
Current Position & Title:
Area of Research Interest (s):
Can you make the dates specified in the supporting information?
Name of NIHR Leader supporting this application?
Name:
Position:
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Yes
No
Please indicate your NIHR Funding (by completing the table below)
My NIHR Funding is…
(please highlight as
appropriate)
Start Date
End Date
(please note that your
award must span the
duration of the
Programme)
NIHR Clinician Scientist
Fellowship
NIHR Clinical Lectureship
NIHR Post-Doctoral
Fellowship
NIHR Career
Development Fellowship
NIHR Senior Research
Fellowship
NIHR Translational
Fellowship
NIHR Clinical Trials
Fellowship
NIHR Knowledge
Mobilisation Research
Fellowship
NIHR Integrated Clinical
Academic Clinical
Lecturer
NIHR Integrated Clinical
Academic Senior Clinical
Lectureship
NIHR Clinical Academic
Training Clinical Lecturer
NIHR Clinical Academic
Training Senior Clinical
Lecturer
NIHR Health Care
Scientist Post-Doctoral
Fellowship
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Reference
Number
(if appropriate)
NIHR Health Care
Scientist Senior Clinical
Lecturer
OR, if you are not holding an NIHR Training Award, please indicate your alternative NIHR
Funding:
Are you a Senior Post-Doctoral Researcher in a NIHR BRC/BRU,
CLAHRC or a Post-Doctoral trainee in an NIHR School (NIHR School for
Social Care Research, NIHR School for Public Health Research and NIHR
School for Primary Care Research)?
Yes
No
If yes….
Please give the name of the BRC/BRU/ other organisation:
Who is the NIHR Senior Leader/ NIHR Professor who is responsible for this funding?
Name:
Email:
Are you a Post-Doctoral trainee funded on an NIHR Programme Grant for Yes
Applied Research?
No
If yes….
What is the number of this Programme Grant?
Who is the NIHR Senior Leader/ NIHR Professor who is responsible for this funding?
Name:
Email:
Are you in a Post-Doctoral research post where salary is funded by
NIHR through an NIHR Professorship?
Yes
No
If yes….
What kind of research post do you hold? (e.g. Academic Clinical Fellow, Clinical Lecturer,
Post-Doctoral Fellow)
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Who is the NIHR Professor who is responsible for this funding?
Name:
Email:
Are you using another source of NIHR funding for your research?
Yes
No
If yes….
Please explain:
Who is the NIHR Senior Leader/ NIHR Professor who is responsible for this funding?
Name:
Email:
Non NIHR Funding & Additional information
Please list other current funding awards and/or previous awards
(with start and end dates):
Award:
Start:
Name of your Line Manager for your research and their position/title:
Name:
Title:
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End date:
Name of Mentor(s) and their position
Name:
Title:
How did you hear about this Programme?
Section 2: Your current management and leadership responsibilities
2.1 How many people do you have direct line management responsibility for in a
research context?
2.2 What are their roles/titles?
2.3 Are there other people you have indirect leadership responsibility for? How many?
What is their relationship to you? (e.g. they could be part of a network or collaborative
project which you lead; you could be their PhD supervisor)
2. 4 What impact do you want your research to have?
Section 3: Getting to know you…
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In this section, we are interested in getting to know you, not in ‘right answers’ or whether you
meet pre-determined criteria. We want to understand if this programme is appropriate and
suitable for you at this stage in your career. We hope you enjoy reflecting as part of this
process.
Please write a maximum of 200 words in response to each question.
3.1 Where and what are you beginning to lead on behalf of NIHR/your
institution/beyond?
3.2 Why are you applying for this Leadership Programme now?
3.3 Please describe a recent leadership experience that you found exhilarating or
challenging… What have you learnt from it about yourself and about your team and/or
organisation?
3.4 What might change as a result of your participation in this programme?
3.5 Reflecting on this application now, what questions do you have about your own
leadership?
Please note that, as Data Processor under Ashridge Business School’s contract with NIHR,
any Personal Data provided in this form will only be processed by Ashridge Business
School as is necessary in order for Ashridge Business School to perform its obligations,
and only in accordance with any instructions given by NIHR, in that contract.
Thank you
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