NHS North West 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

First name *
Last name *
E-mail address *
NHS email address required
Organisation *
Organisation region *
Job title *
Telephone number *
Work type *
HLM Facilitator
Consent to storage and use of your personal data *

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

I would like to support the following group of coachees *
Eligibility to access as a coach *
If currently ineligible to access the NHS NWLA Coaching Register you can find out more information about our free to access mentoring scheme at www.nwacademy.nhs.uk/mentoring open to all NHS staff across the North West
Please provide detailed information regarding your formal coaching qualification or equivalent coaching experience *
I would describe myself as a coach who: *
I have experience in and am willing to work with a coachee to help them *
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 *
Interests in coaching *
Please write a brief description of:
– Why you want to support coachees through the NHS North West Coaching Scheme
– Your motivation for becoming a coach
Coaching experience *
Please indicate your level of coaching experience and any previous experience of coaching you may have had along with any other information which would be useful to a potential coachee. Please think about your strengths and use the topics below as a guide. Experience of:
– Change Management
– Leadership
– Family/Work Balance
– Rapid Career Development
– Involvement in other Development Programmes
– Personal Approach and Style of Mentoring
– Non-NHS Background
Are you a trained coaching supervisor? *
Are you a Healthcare Leadership Model (HLM) 360 feedback facilitator? *
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

Gender identity. Which of the following options best describes how you think of yourself?  *
Is your gender identity the same as the gender you were given at birth? *
Your age group *
How would you describe your ethnic origin? *
Your religion or belief *
Which of the following options best describes how you think of yourself? *
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 and Mentoring Hub is based on the CRBhub management system from CRB Associates