NHS North East Leadership Academy

Coaching Hub

Register as a coach

To register as a coach, please complete this form, filling in the requested information or ticking the boxes. The more information you provide, the easier it will be for the right people to find your profile.

To move between sections, click 'Next' or the required tab. When you have completed all sections, please click 'Submit my application now'.

nb. please do not use your browser's 'Back' and 'Forward' buttons, otherwise you may lose information that you have entered.

About you

Please tell us some details about yourself.

* denotes a required field

Title  
First name *
Last name *
E-mail address *
Organisation *
Job title *
Address line 1 *
Address line 2
Address line 3
Town *
County
Postcode *
Telephone number *
Alternative telephone number
Clinical background

Coach details

Please provide the following details specifically with regard to your eligibility to register as a coach and to your coach profile.

* denotes a required field

Supervision received?   
Please specify your supervision provider and date of your most recent supervision:
Provider:
Date:
Time:
:
Duration:
Clinical status
Clinical group
Coach comments
I have experience in and am willing to work with someone to help them *
I am willing to enter into a coaching relationship that is *
I am willing to work within the following geographical area *
I would prefer my coaching to take place via *
Please provide detailed information regarding your formal coaching qualification or equivalent coaching experience
Coaching accreditation *
Interests in coaching *
Coaching experience *
Any other useful information
Are you a Healthcare Leadership Model (HLM) 360 feedback facilitator? *
Supervision requirements *
CPD requirements *
Number of coaching relationships I am willing to have at any one time *
 
Supporting document
e.g. biography, record of contractual agreement – optional (Word, Excel or PDF files accepted)

Coachee details

If you do not wish to register as a coachee, please click 'Next'.

Diversity & Inclusion

The following questions are for D&I monitoring purposes only, and the information provided will not be made available to other users:

* denotes a required field

Your gender *
Your age group *
How would you describe your ethnic origin? *
Your religion or belief *
Please select the option which best describes your sexuality *
Do you consider yourself to be a disabled person as defined by the Equality Act 2010*
If you consider yourself to be a disabled person, and would like to, please indicate the nature of your disability (tick as many as are applicable)
Other disability - please specify

Coaching agreement


 

CRBhub Coaching Hub is based on the CRBhub management system from CRB Associates