Aspiring Registrar and COO Programme application form

"*" indicates required fields

Title

First Name*

Preferred Name

Family/Last Name*

Position Held*

Department

Institution*

Please enter a Purchase Order number, or indicate if one will be sent*

(as entry to the programme is on a competitive basis, you may wish to delay sending a PON until your place has been confirmed)

Address for correspondence*

Street Address Address Line 2 City Postal Code

Address for invoice (if different)

Street Address Address Line 2 City Postal Code

Delegate Email*

PA's Name

Delegate Mobile

PA's Email

Delegate Direct Line

PA's Phone

Have you taken part in any other management / leadership development programmes?

Yes

If yes, please state which ones

Ethnicity*

Gender*

If self describing, please state

Special Dietary Requirements – please indicate those that apply

Vegetarian

Vegan

Halal

Kosher

No Seafood

No Dairy

Food allergies please state

Other requirements

Application Documents Required: Please upload*

• One page personal statement outlining your experience and motivation for seeking to join the Programme;

• Copy of your CV;

• Letter of commitment from a member of the University Executive confirming that the time and funding will be made available together with an indication of what they hope you will gain from the Programme.

Max. file size: 20 MB.

Please tell us how you found out about the Programme:

Signature*

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