Future leaders in Anaesthesia Leadership Development Programme delivered by the Association of Anaesthetists of Great Britain and Ireland in partnership with Bayes Business School

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CLINICAL DIRECTOR/EDUCATIONAL SUPERVISOR/TRAINING PROGRAMME DIRECTOR SPONSORSHIP

Applicants must be supported by their Training Programme Director/ College Tutor/ Educational Supervisor and/or Clinical Director.

By completing this form, you confirm that:

• You are fully aware of the applicant’s submission for the Anaesthetists’ Leadership Development Programme.

• You endorse and support their participation in the programme.

• You will ensure reasonable study leave is granted to enable full attendance at all programme sessions.

APPLICANT DETAILS

Please fill in the name and membership of the candidate you are sponsoring:

First name

Last name

YOUR DETAILS

Title

First name

Last name

Job title

Department

NHS Trust

Hospital address

Phone number

I am the applicant's:

Supporting statement (Optional, max. 200 words):

Do you confirm that you support this application and will facilitate the necessary leave and support for the applicant to attend the full programme?

I confirm

Type Clinical Lead's name (serves as signature)

Date