1Intro2Basic Information3Eligibility4Employment details5Funding6Additional Information Unique IDHiddenDate DD slash MM slash YYYY Applying for The Imperial College and Corndel Executive Leadership Diploma Thank you for your interest in this programme. The information you provide in this form will help us to assess your eligibility and suitability. It will take around 30-45 minutes to complete and does not need to be finished in one go. Due to high demand, we recommend you submit your application as soon as possible to maximise your chances of earning a place on the February 2022 cohort. If you have any questions related to this application form, please email mollie.gardner@corndel.com for support. Thanks again for your interest and we look forward to receiving and reviewing your application soon. Kind regards, The Imperial College and Corndel Team Name* First Last Your job title* Work email address* Enter Email Confirm Email Your phone number* We will always store your personal details securely. We will use them to provide the service that you have requested and communicate with you using the details you have provided in the form. Your data may also be used for analysis purposes, to help us provide the best service possible. We will only allow your information to be used by partners working on our behalf and only share it if required to do so by law. View our Privacy Policy.Consent* I agree to Corndel’s use of my information and have read the Privacy Policy.* The Imperial College and Corndel Executive Leadership Diploma is funded using government funding know as the apprenticeship levy which means strict eligibility criteria applies. A full eligibility check is completed on all successful applicants and supporting information will need to be provided to start the programme in February 2022. Please answer the questions below to enable to the Corndel team to provisionally confirm your eligibility for this programme. Do you live in England?* Yes No Do you spend at least 50% of your time working in England?* Yes No What level is your highest qualification?*Please select...GCSEs or equivalentA-Levels or equivalentUndergraduate degree or equivalentMasters degree or equivalentOtherPlease provide the name of your highest qualification (e.g. BSc Maths)* Are you currently working towards any other qualification?* Yes No Please provide further information, including name of qualification, name of education or training provider, and expected date of completion.*Which of the following statements best describes you?* I am a UK or EU/EEA citizen and have lived in the UK or EU/EEA countries for the last three years; I am not an EU/EEA citizen, and I have the right to work and be ordinarily resident in the UK for the last three years; or None of the above How many hours do you work each week?* Less than 30 30 or more Name of your employer*Please note, we will not contact your employer without your permission Registered company address of your employer* Street Address Address Line 2 City Region Post code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country If your employer is part of a larger group of companies, please provide the name of that group below How many people does your company employ (estimate)?*Please select...Less than 2020-4950-99100-499500+ To draw down funding for this programme we will need to engage with your employer. This is typically the person responsible for Learning and Development but could be another senior leader. Once your application has been accepted, a member of the Corndel team will be in touch to discuss next steps and begin the process of engaging the relevant stakeholders within your organisation. Your support during this process will be essential to ensure smooth onboarding ahead of the programme starting in February 2022. It is not possible to pay for this programme privately. Does your employer pay the apprenticeship levy?* Yes No I don't know Do you know who is responsible for managing the apprenticeship levy for your employer?* Yes No The apprenticeship levy is paid by all organisations with an annual pay bill of more than £3m. More information can be found here for support. Have you spoken to a line manager or other senior colleague about your application for this programme?* Yes No How many years experience do you have managing people?*Please select...Less than 5 years5-7 years8-10 yearsMore than 10 yearsPlease describe your current leadership and management responsibilities. Relevant information may include the number of people you manage, size of budget, and a high-level description of your key responsibilities.*Why do you want to join The Imperial College and Corndel Executive Leadership Diploma?*
