South East Talent and Leadership Network Expression of Interest Expression of Interest Form – new South East Talent and Leadership Network Terms and Conditions* Yes No (Form will not be accepted) By completing and submitting this form: I hereby give SELA consent to keep a record of my name, job role, organisation, band (if applicable), telephone number and email address on their secure contacts database for management information and communication purposes. Please see our Privacy Notice. You can opt-out of these arrangements at any point by contacting us at [email protected]. In preparation for the first session of the South East (SE) Talent and Leadership Network, we would like to hear your thoughts and preferences on the focus areas that are most important to you.Does your role or portfolio include responsibilities related to leadership, talent or organisational development* Yes – please continue this form No – this is probably not the right network/space for you so there is no need to complete the form. However, we hope we can engage with you in another network or way in the future. What specific goals would you like to achieve through your involvement in the SE Talent and Leadership Network?*Please provide your contact details below:First Name* Surname* Role / Job Title* Organisation*Ashford & St Peters Hospitals NHS Foundation TrustBerkshire Healthcare NHS Foundation TrustBerkshire West CCGBrighton & Hove CCGBrighton and Hove City CouncilBrighton and Sussex University Hospitals NHS TrustBuckinghamshire CCGBuckinghamshire Healthcare NHS Foundation TrustCentral Surrey HealthDartford and Gravesham NHS TrustEast Berkshire CCGEast Kent Hospitals University NHS Foundation TrustEast Sussex CCGEast Sussex County CouncilEast Sussex Healthcare NHS TrustFareham and Gosport CCGFirst Community Health and CareFrimley Park Health NHS Foundation TrustHampshire & Isle of Wight Partnership of CCGsHampshire Hospitals NHS Foundation TrustIndependentIntegrated care 24Isle of Wight CCGIsle of Wight NHS Foundation TrustKent & Medway NHS & Social Care Partnership TrustKent and Medway CCGKent Community Health NHS Foundation TrustKent County CouncilMaidstone & Tunbridge Wells NHS TrustMedway Community Healthcare CICMedway CouncilMedway NHS Foundation TrustNorth East Hampshire & Fareham CCGNorth Hampshire CCGOxford Health NHS Foundation TrustOxford University Hospitals NHS TrustOxfordshire CCGPortsmouth CCGPortsmouth Hospital NHS TrustQueen Victoria Hospital NHS Foundation TrustRoyal Berkshire NHS Foundation TrustRoyal Surrey County Hospital NHS Foundation TrustSolent NHS TrustSouth Central Ambulance Service NHS Foundation TrustSouth East Coast Ambulance Service NHS Foundation TrustSouth Eastern Hampshire CCGSouth, Central and West CSUSouthampton City CCGSouthern Health NHS Foundation TrustSurrey & Borders Partnership NHS Foundation TrustSurrey and Sussex Healthcare NHS TrustSurrey County CouncilSurrey Heartlands CCGSussex Community NHS Foundation TrustSussex Partnership NHS Foundation TrustUniversity Hospital Southampton NHS Foundation TrustWest Hampshire CCGWest Sussex CCGWest Sussex County CouncilWestern Sussex Hospitals NHS Foundation TrustOtherIf you selected 'Other' to the previous question, please specify. Please select the ICB your organisation is inBuckinghamshire, Oxfordshire and Berkshire West ICBFrimley Health and Care ICBHampshire and Isle of Wight ICBSurrey Heartlands Health and Care Partnership ICBSussex Health and Care Partnership ICBKent and Medway ICBI do not knowOtherIf you selected Other, please specify: E-mail Address* Contact Phone Number* CommentsThis field is for validation purposes and should be left unchanged.