Application Expression of Interest

As part of the selection process your answers to this form will be shared amongst the programme delivery partners. Please tick the box below to consent to this.

I have read and understand the above.

Your name*

Your Job Title*

Organisation Name*

Email Address*

example@example.com

Phone Number

Phone Number*

Please enter a valid phone number.

Please provide contact information for a colleague who will be supporting you in this work:*

Please provide a brief description of your organisation:*

What is your organisation's connection to the boroughs of Lambeth and or Southwark*

What is your organisation's annual turnover? *

Please provide an insight into your current governance structure (e.g how many people sit on the board, do you have any sub-committees?) If your organisation is part of a wider partnership please detail this here*

Are you confident in obtaining the approval of your Board to take part in this programme, and are they willing to induct and support a new co-opted board member with an interest in enhancing Diversity, Equity and Inclusion (DEI) across the organisation? *

How often does your board meet?*

Who would be responsible within your organisation for leading on the work undertaken on the Transformational Leadership Programme? *

Has your organisation previously received support or training on issues related to DEI and what was the impact?*

Does your organisation currently have any of the following:*

Diversity and Inclusion StatementDiversity and Inclusion CommitteeDiversity and Inclusion Action PlanEmployee Resource Groups or staff forums e.g BAME staff Network, LGBTQ+ employee groupNone of the above

Has your organisation undertaken any surveying activities with regards to DEI. If yes, please provide a brief outline of what this entailed and when the activities took place. *

Does your organisation currently keep records relating to the demographic/diversity statistics of its staff or Board?*

Does your organisation currently keep records relating to the demographic/diversity statistics of its service users?*

This programme aims to reduce health and wellbeing inequalities in Lambeth and Southwark. How would an increased understanding of DEI amongst your staff and service users support this?*

How do you think this programme will help to progress your organisation's DEI ambitions over the next 1-3 years?*

Where did you hear about this opportunity?*

Which intake works best for your organisation (you may select more than one option)

Summer 2022Autumn 2022Winter 20222023

Is there any further information you feel it would be useful for us to know about your organisation's activities or structure?*

The second stage of the application process is a call with the delivery partners - please list 3 suitable times. If possible we recommend the person responsible for leading on this work attends the call along with a member of your board / a trustee.*

Data Protection Notice

Maintaining the confidentiality of your information is of utmost concern to us. The information collected as part of this form will be held in confidence and will only be used for the purpose set out in relation to advisory. For the purposes of the General Data Protection Regulation ("GDPR") and UK data protection laws, the data controller is INCLUSIVE BOARDS LIMITED. To find out more about how we store and process data, please visit https://www.inclusiveboards.co.uk/privacy-policy/

How will the information be used (data)?

Data management will follow General Data Protection Regulation ("GDPR") and UK data protection laws. We will not publish any information about you that could identify you to someone else publicly. Data provided to us will be used for the purposes set out at the time of collection and, where relevant, in accordance with any preferences you express.

Who will the data be shared with?

By answering the questions you are giving consent to having your data stored and processed by Inclusive Boards for the purposes of advisory. Inclusive Boards may share information disclosed in this form with Impact on Urban Health and Do It Now Now for the purpose of assessing suitability for participation in the programme. Inclusive Boards will not be sharing any data collected with any entity outside of the EEA.

Your rights under GDPR

You have the right to withdraw your answers to this form at anytime by contacting data@inclusiveboards.co.uk. You also have the right to request to review, modify or delete your responses at any time. You can find the full list here of your rights under GDPR here: https://ico.org.uk

Please attach a copy of your most recent impact report

For Organisations:

Organisation Information

Organisation Implentation of DEI

Motivations for joining the Transformational Leadership Programme

Additional Information